Healthcare Provider Details

I. General information

NPI: 1750270971
Provider Name (Legal Business Name): AMERIS IKEDA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2025
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1483 ALVA ST
CARPINTERIA CA
93013-1501
US

IV. Provider business mailing address

336 W SHOSHONE ST
VENTURA CA
93001-0332
US

V. Phone/Fax

Practice location:
  • Phone: 805-566-0299
  • Fax:
Mailing address:
  • Phone: 805-318-5005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: