Healthcare Provider Details

I. General information

NPI: 1396230132
Provider Name (Legal Business Name): ASHLEY NICOLE AHEARN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY NICOLE PIMENTEL

II. Dates (important events)

Enumeration Date: 06/25/2018
Last Update Date: 08/14/2020
Certification Date: 08/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 FLYNN RD
CAMARILLO CA
93012-8704
US

IV. Provider business mailing address

1722 S LEWIS RD
CAMARILLO CA
93012-8520
US

V. Phone/Fax

Practice location:
  • Phone: 805-464-8622
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: