Provider Demographics
NPI:1104487776
Name:OXNARD MEDICAL GROUP INC
Entity type:Organization
Organization Name:OXNARD MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMABLE
Authorized Official - Middle Name:R
Authorized Official - Last Name:AGUILUZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:M D
Authorized Official - Phone:818-762-2084
Mailing Address - Street 1:12511 OXNARD ST
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-4458
Mailing Address - Country:US
Mailing Address - Phone:818-762-2084
Mailing Address - Fax:818-762-2085
Practice Address - Street 1:12511 OXNARD ST
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-4458
Practice Address - Country:US
Practice Address - Phone:818-762-2084
Practice Address - Fax:818-762-2085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty