Provider Demographics
NPI:1548285307
Name:OXNARD CAMARILLO ANESTHESIOLOGY MEDICAL GROUP
Entity type:Organization
Organization Name:OXNARD CAMARILLO ANESTHESIOLOGY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:P
Authorized Official - Last Name:BELLEVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-440-3131
Mailing Address - Street 1:3116 W MARCH LN
Mailing Address - Street 2:STE. 200
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-2369
Mailing Address - Country:US
Mailing Address - Phone:209-473-6555
Mailing Address - Fax:209-473-6544
Practice Address - Street 1:2309 ANTONIO AVE
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-1414
Practice Address - Country:US
Practice Address - Phone:805-988-2500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0081300Medicaid
CACF8796OtherRAILROAD MEDICARE
CAW14219BMedicare PIN
CAW14219AMedicare PIN
CAA61342Medicare PIN
CACF8796OtherRAILROAD MEDICARE