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Organization
VENTANA HEALTH AND MEDICAL CENTER
Active
Organization
VENTANA HEALTH AND MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MEGAN M ELLMAN MD (VP)
(805) 489-2205
Entity
Organization
Contact information
Practice address
901 OAK PARK BLVD, SUITE 101, PISMO BEACH, CA 93449-3216
(805) 489-2205
(805) 489-2206
Mailing address
PO BOX 1410, PISMO BEACH, CA 93448-1410
(805) 489-2205
(805) 489-2206
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2537515
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ07475Z
BLUE SHIELD OF CALIFORNIA
CA
Enumeration date
11/23/2005
Last updated
11/10/2010
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