Organization
VENTURA DERMATOLOGY MEDICAL CLINIC, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN HOLLISTER THACHER M.D. (PRESIDENT/PHYSICIAN)
(805) 648-6969
Entity
Organization
Contact information
Practice address
227 N DOS CAMINOS AVE, VENTURA, CA 93003-1660
(805) 648-6969
(805) 648-3762
Mailing address
115 PIRIE RD STE F, OJAI, CA 93023-3100
(805) 648-6969
(805) 648-3762
Taxonomy
Speciality
Code
Description
License number
State
207ND0900X
Dermatopathology Physician
Primary
G18881
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ71761Z
BLUE SHIELD
CA
Enumeration date
07/14/2006
Last updated
03/06/2025
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