Provider Demographics
NPI:1679451488
Name:USCG AIRSTA VENTURA
Entity type:Organization
Organization Name:USCG AIRSTA VENTURA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH SERVICES ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:R
Authorized Official - Last Name:ESHAM
Authorized Official - Suffix:
Authorized Official - Credentials:HS1
Authorized Official - Phone:805-502-9989
Mailing Address - Street 1:190 3RD STREET
Mailing Address - Street 2:
Mailing Address - City:NAVAL AIR STATION POINT MUGU
Mailing Address - State:CA
Mailing Address - Zip Code:93042
Mailing Address - Country:US
Mailing Address - Phone:805-874-3260
Mailing Address - Fax:
Practice Address - Street 1:190 3RD STREET
Practice Address - Street 2:
Practice Address - City:NAVAL AIR STATION POINT MUGU
Practice Address - State:CA
Practice Address - Zip Code:93042
Practice Address - Country:US
Practice Address - Phone:805-874-3260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:USCG
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-08-21
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient