Healthcare Provider Details

I. General information

NPI: 1346968385
Provider Name (Legal Business Name): AIMEE LYN DEBACKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2022
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4660 MISSION OAKS BLVD
CAMARILLO CA
93012-5199
US

IV. Provider business mailing address

PO BOX 382
CAMARILLO CA
93011-0382
US

V. Phone/Fax

Practice location:
  • Phone: 805-389-6407
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number141211
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: