CHANING TIDES TREATMENT NPI 1508315250

NPI Information

  • NPI: 1508315250
  • Provider Name: CHANING TIDES TREATMENT
  • Classification: Family Medicine - 207QA0401X
  • Specialization: Addiction Medicine
  • Entity Type: Organization
  • Address: 2021 SPERRY AVE
    SUITE 18
    VENTURA, CA
    ZIP 93003
  • Phone: (844) 883-3869

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NPI Details

CHANING TIDES TREATMENT is an addiction medicine family medicine in Ventura, CA. The provider is a family medicine physician who specializes in the diagnosis and treatment of addictions. CHANING TIDES TREATMENT NPI is 1508315250. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

2021 SPERRY AVE
SUITE 18
VENTURA, CA
ZIP 93003-408
Phone: (844) 883-3869
Fax: (805) 624-5311

The provider's authorized official is Angela Iacullo .
The authorized official title is Billing and has the following contact phone number (954) 415-8781.

The enumeration date for this NPI number is 9/22/2016 and was last updated on 9/22/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207QA0401XFamily MedicineAddiction MedicineYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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