Santa Clara Valley Medical Group Inc.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

A55866 Issued in CA

Legal business name

SANTA CLARA VALLEY MEDICAL GROUP INC.

Practice address

147 N Brent St
Ventura, CA 93003-2809

Phone

(805) 652-5011

Fax

(805) 667-2865

NPI assigned

Feb 21, 2007

Organization subpart

No

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

Authorized official

Name

Victor Dominguez, M.D.

Title

President

Phone

(805) 525-9595

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1172016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1629103890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2705 LOMA VISTA RD",
            "address_2": "SUITE 205",
            "city": "VENTURA",
            "state": "CA",
            "postal_code": "930031581",
            "telephone_number": "805-667-2801",
            "fax_number": "805-667-2865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "147 N BRENT ST",
            "city": "VENTURA",
            "state": "CA",
            "postal_code": "930032809",
            "telephone_number": "805-652-5011",
            "fax_number": "805-667-2865"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANTA CLARA VALLEY MEDICAL GROUP INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DOMINGUEZ",
        "authorized_official_first_name": "VICTOR",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "805-525-9595",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A55866",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI-CAL",
            "identifier": "0103120",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• 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.