Provider Demographics
NPI:1346065976
Name:PRIMARY MEDICAL GROUP OF VENTURA
Entity type:Organization
Organization Name:PRIMARY MEDICAL GROUP OF VENTURA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHERILYN
Authorized Official - Middle Name:CHANTAL
Authorized Official - Last Name:WHEATON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-647-7704
Mailing Address - Street 1:26 S GARDEN ST STE I
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93001-4524
Mailing Address - Country:US
Mailing Address - Phone:805-507-2225
Mailing Address - Fax:
Practice Address - Street 1:117 PIRIE RD STE D
Practice Address - Street 2:
Practice Address - City:OJAI
Practice Address - State:CA
Practice Address - Zip Code:93023-3166
Practice Address - Country:US
Practice Address - Phone:805-646-7246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty