Chaning Tides Treatment

Primary specialty

Addiction Medicine (Family Medicine) PhysicianTaxonomy code 207QA0401X

Legal business name

CHANING TIDES TREATMENT

Practice address

2021 Sperry Ave
Suite 18
Ventura, CA 93003-7408

Phone

(844) 883-3869

Fax

(805) 624-5311

NPI assigned

Sep 22, 2016

Organization subpart

No

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

Authorized official

Name

Angela Iacullo

Title

Billing

Phone

(954) 415-8781

Specialties & licenses 1

Addresses

Tax ID family

Changing Tides Treatment LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Changing Tides Treatment LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Ventura, CA
  • NPI 1053701425
  NPD tax ID

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

{
    "created_epoch": "1474502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474502400000",
    "number": "1508315250",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2021 SPERRY AVE",
            "address_2": "SUITE 18",
            "city": "VENTURA",
            "state": "CA",
            "postal_code": "930037408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2021 SPERRY AVE",
            "address_2": "SUITE 18",
            "city": "VENTURA",
            "state": "CA",
            "postal_code": "930037408",
            "telephone_number": "844-883-3869",
            "fax_number": "805-624-5311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHANING TIDES TREATMENT",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-22",
        "last_updated": "2016-09-22",
        "status": "A",
        "authorized_official_last_name": "IACULLO",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_title_or_position": "BILLING",
        "authorized_official_telephone_number": "954-415-8781"
    },
    "taxonomies": [
        {
            "code": "207QA0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Diana Juhee Chang
• Kyung Sook Chang
• Li-Wen Chang
• Steven David Chang, M.D.
• Changing Tides Treatment LLC
• Channel Islands Prosthetics-Orthotics
• Channel Islands Rehab, LLC
• Channel Islands Rehab, LLC
• Audree Chapman, LMFT
• Pamela L Chapman, LMFT

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2016; 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.