Provider Demographics
NPI:1194910422
Name:AUGUSTO FOCIL MD A PROFESSIONAL CORP
Entity type:Organization
Organization Name:AUGUSTO FOCIL MD A PROFESSIONAL CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:FOCIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-486-6565
Mailing Address - Street 1:300 S A ST
Mailing Address - Street 2:#105
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-5822
Mailing Address - Country:US
Mailing Address - Phone:805-486-6565
Mailing Address - Fax:805-486-0740
Practice Address - Street 1:300 S A ST
Practice Address - Street 2:#105
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-5822
Practice Address - Country:US
Practice Address - Phone:805-486-6565
Practice Address - Fax:805-486-0740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 207R00000X, 2083P0901X
CAA44207305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A442070Medicaid
CAGR0105640Medicaid
CAGR0105640Medicaid
CAGR0105640Medicaid
CAA44207Medicare PIN
CABF1275331OtherDEA NUMBER