Healthcare Provider Details

I. General information

NPI: 1346373834
Provider Name (Legal Business Name): TAMI J COSTIGAN LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1722 S LEWIS RD
CAMARILLO CA
93012-8520
US

IV. Provider business mailing address

651 FOXGLOVE PL
OXNARD CA
93036-2328
US

V. Phone/Fax

Practice location:
  • Phone: 805-445-7800
  • Fax: 805-445-7830
Mailing address:
  • Phone: 805-258-2335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN178258
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: