Individual
JOHN CHARLES GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2795 LOMA VISTA RD, VENTURA, CA 93003-1544
(805) 643-8695
(805) 643-2087
Mailing address
2795 LOMA VISTA RD, VENTURA, CA 93003-1544
(805) 643-8695
(805) 643-2087
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
G36782
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050394
BLUE CROSS
CA
01
—
951683892
OTHER INSURANCE
CA
01
—
953152550
OTHER INSURANCE
CA
05
—
RHM08608F
—
CA
05
—
RHM08609F
—
CA
05
—
RHM18553H
—
CA
05
—
ZZT40394F
—
CA
05
—
ZZZ82842Z
—
CA
Enumeration date
07/20/2006
Last updated
07/09/2007
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