Provider Demographics
NPI:1043298490
Name:FAMILY TO FAMILY MEDICAL CENTER INC
Entity type:Organization
Organization Name:FAMILY TO FAMILY MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:PENA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-659-1166
Mailing Address - Street 1:970 PETIT AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93004-2215
Mailing Address - Country:US
Mailing Address - Phone:805-659-1166
Mailing Address - Fax:805-659-5765
Practice Address - Street 1:970 PETIT AVE
Practice Address - Street 2:SUITE D
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93004-2215
Practice Address - Country:US
Practice Address - Phone:805-659-1166
Practice Address - Fax:805-659-5765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW18820Medicare ID - Type Unspecified