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Organization
CI MARINA MEDICAL INC
Active
Organization
CI MARINA MEDICAL INC
Active
Other names
Gary R Mitnick DO
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARY ROBERT MITNICK D.O. (PRESIDENT)
(805) 985-5880
Entity
Organization
Contact information
Practice address
4310 TRADEWINDS DR, STE 300, OXNARD, CA 93035-1407
(805) 985-5880
(805) 984-9839
Mailing address
4310 TRADEWINDS DR, STE 300, OXNARD, CA 93035-1407
(805) 985-5880
(805) 984-9839
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
20A4379
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20A4379
MEDICAL LICENSE NUMBER
CA
Enumeration date
12/29/2009
Last updated
09/20/2010
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