Healthcare Provider Details

I. General information

NPI: 1093334674
Provider Name (Legal Business Name): JOSSELYN LEMUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2020
Last Update Date: 01/03/2022
Certification Date: 01/03/2022
Deactivation Date: 11/10/2021
Reactivation Date: 12/30/2021

III. Provider practice location address

5284 ADOLFO RD STE 100
CAMARILLO CA
93012-6790
US

IV. Provider business mailing address

5284 ADOLFO RD STE 100
CAMARILLO CA
93012-6790
US

V. Phone/Fax

Practice location:
  • Phone: 805-289-0120
  • Fax:
Mailing address:
  • Phone: 805-289-0130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: