Brent Street Family Practice

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

G43925 Issued in CA

Legal business name

BRENT STREET FAMILY PRACTICE

Practice address

168 N Brent St
Ste 502
Ventura, CA 93003-2817

Phone

(805) 641-2000

Fax

(805) 653-1644

NPI assigned

Jan 18, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Robert F Dodge, M.D

Title

President

Phone

(805) 641-2000

Specialties & licenses 4

Addresses

Other identifiers 4

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1063565604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "168 N BRENT ST",
            "address_2": "STE 502",
            "city": "VENTURA",
            "state": "CA",
            "postal_code": "930032817",
            "telephone_number": "805-641-2000",
            "fax_number": "805-653-1644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "168 N BRENT ST",
            "address_2": "STE 502",
            "city": "VENTURA",
            "state": "CA",
            "postal_code": "930032817",
            "telephone_number": "805-641-2000",
            "fax_number": "805-653-1644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRENT STREET FAMILY PRACTICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DODGE",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "805-641-2000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G43925",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G40594",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G26650",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G46052",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G266500",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G405940",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G460520",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G439250",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kenna Jean Bray
• Leah Breen
• Megan B Brennan
• Theresa Brenner-Farrell, LMFT
• Charles Brenner, M.D.
• Brian D. Brantner, M.D. a Professional Corporation
• Brian T Barker, D.D.S., M.S., Inc.
• Olivia Rose Brice
• Bridge & Temple Inc
• Brierwood Terrace Ventura Inc.

• Family Medicine Physician in Ventura, CA
• Providers in Ventura, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.