| Rose Avenue Family Medical Group A Professional Corporation | |
|
451 W Gonzales Rd Ste 230 Oxnard CA 93036 | |
| (805) 988-1443 | |
| (805) 988-0897 |
| Full Name | Rose Avenue Family Medical Group A Professional Corporation |
|---|---|
| Speciality | Family Medicine |
| Location | 451 W Gonzales Rd Ste 230, Oxnard, California |
| Authorized Official Name and Position | Josephine Soliz (PRESIDENT) |
| Authorized Official Contact | 8059881443 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rose Avenue Family Medical Group A Professional Corporation 451 W Gonzales Rd Ste 230 Oxnard CA 93036-0726 Ph: (805) 988-1443 | Rose Avenue Family Medical Group A Professional Corporation 451 W Gonzales Rd Ste 230 Oxnard CA 93036 Ph: (805) 988-1443 |
| NPI Number | 1114019015 |
|---|---|
| Provider Enumeration Date | 09/28/2006 |
| Last Update Date | 08/20/2018 |
| Medicare PECOS PAC ID | 1254301096 |
|---|---|
| Medicare Enrollment ID | O20040729001582 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114019015 | NPI | - | NPPES |
| ZZZ38731Z | Other | CA | BLUE SHIELD GROUP NUMBER |
| GR0028670 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Maria Del Rocio Villasenor |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1114147402 PECOS PAC ID: 1153417118 Enrollment ID: I20071022000765 |
| Provider Name | Autumn Marie Edwards |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1669535597 PECOS PAC ID: 6305936857 Enrollment ID: I20071220000286 |
| Provider Name | John Michael Ippolito |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1376607846 PECOS PAC ID: 7315004769 Enrollment ID: I20090330000433 |
| Provider Name | John Ralph Ford |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1699851188 PECOS PAC ID: 2769650415 Enrollment ID: I20110722000629 |
| Provider Name | Kristen Kay Anderson Loghry |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1790161628 PECOS PAC ID: 9234477175 Enrollment ID: I20190219000882 |
| Provider Name | Helen E Ashton |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1730619198 PECOS PAC ID: 4284045584 Enrollment ID: I20201117001990 |
| Provider Name | Mariela Varis |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1043704877 PECOS PAC ID: 0446654214 Enrollment ID: I20210802003169 |
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