Provider Demographics
NPI:1902486517
Name:INTERNAL MEDICINE OF VENTURA
Entity Type:Organization
Organization Name:INTERNAL MEDICINE OF VENTURA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYEE PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-914-5808
Mailing Address - Street 1:3901 LAS POSAS RD STE 103
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-1505
Mailing Address - Country:US
Mailing Address - Phone:805-914-5808
Mailing Address - Fax:805-702-4135
Practice Address - Street 1:3901 LAS POSAS RD STE 103
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-1505
Practice Address - Country:US
Practice Address - Phone:805-750-4355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-09
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty