Organization
VISTA DEL MAR MEDICAL GROUP, INC
Active
Other names
N/A
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD K WESTERDOLL CAAMA, CMM (EXECUTIVE DIRECTOR)
(805) 983-0691
Entity
Organization
Contact information
Practice address
1200 W GONZALES RD, SUITE 300, OXNARD, CA 93036-3072
(805) 983-0691
(805) 981-1643
Mailing address
1200 W GONZALES RD, SUITE 300, OXNARD, CA 93036-3072
(805) 983-0691
(805) 981-1643
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
FNP4189
CA
207RN0300X
Nephrology Physician
Primary
FNP4189
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110039977
MEDICARE RAILROAD
CA
01
—
ZZZ34679Z
BLUE CROSS
CA
05
—
ZZZ75566Z
—
CA
Enumeration date
07/02/2006
Last updated
11/12/2021
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