Organization
CHANING TIDES TREATMENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELA IACULLO (BILLING)
(954) 415-8781
Entity
Organization
Contact information
Practice address
2021 SPERRY AVE, SUITE 18, VENTURA, CA 93003-7408
(844) 883-3869
(805) 624-5311
Mailing address
2021 SPERRY AVE, SUITE 18, VENTURA, CA 93003-7408
Taxonomy
Speciality
Code
Description
License number
State
207QA0401X
Addiction Medicine (Family Medicine) Physician
Primary
—
—
Other
Enumeration date
09/22/2016
Last updated
09/22/2016
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