Provider Demographics
NPI:1780762617
Name:VENTURA COUNTY HEALTH DEPT LABORATORY
Entity type:Organization
Organization Name:VENTURA COUNTY HEALTH DEPT LABORATORY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LABORATORY DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHM
Authorized Official - Phone:805-981-5131
Mailing Address - Street 1:2240 E GONZALES RD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-8210
Mailing Address - Country:US
Mailing Address - Phone:805-981-5131
Mailing Address - Fax:805-981-5130
Practice Address - Street 1:2240 E GONZALES RD
Practice Address - Street 2:SUITE 160
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-8210
Practice Address - Country:US
Practice Address - Phone:805-981-5131
Practice Address - Fax:805-981-5130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1565291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1565OtherLAB LICENSE NUMBER
O5D0668137OtherCLIA