Healthcare Provider Details

I. General information

NPI: 1508308941
Provider Name (Legal Business Name): ENSIGN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2016
Last Update Date: 11/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 CORTE REGALO
CAMARILLO CA
93010-9107
US

IV. Provider business mailing address

680 CORTE REGALO
CAMARILLO CA
93010-9107
US

V. Phone/Fax

Practice location:
  • Phone: 805-216-7633
  • Fax:
Mailing address:
  • Phone: 805-216-7633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number3736
License Number StateCA

VIII. Authorized Official

Name: MR. STEVEN ARTHUR MONZON I
Title or Position: PHYSICAL THERAPIST ASSISTANT
Credential: PTA
Phone: 805-216-7633