Healthcare Provider Details

I. General information

NPI: 1780853226
Provider Name (Legal Business Name): VONDA K. KECES CATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2008
Last Update Date: 02/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 ROSEWOOD AVE SUITE 215
CAMARILLO CA
93010-5914
US

IV. Provider business mailing address

450 ROSEWOOD AVE SUITE 215
CAMARILLO CA
93010-5914
US

V. Phone/Fax

Practice location:
  • Phone: 805-482-1265
  • Fax: 805-389-5295
Mailing address:
  • Phone: 805-482-1265
  • Fax: 805-389-5295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1692-I
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: