Organization
VENTURA PODIATRY GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RANDOLPH WARD NORDYKE D.P.M (PRESIDENT)
(805) 650-8333
Entity
Organization
Contact information
Practice address
4080 LOMA VISTA RD, SUITE #D, VENTURA, CA 93003-1811
(805) 650-8333
(805) 650-8382
Mailing address
4080 LOMA ROAD, SUITE D, VENTURA, CA 93003-1811
(805) 650-8333
(805) 650-8382
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
E4245
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
E4245
STATE PTAN
CA
Enumeration date
03/30/2012
Last updated
03/30/2012
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