Healthcare Provider Details

I. General information

NPI: 1235244237
Provider Name (Legal Business Name): JON POWER MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 05/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 SYCAMORE AVE
LA CRESCENTA CA
91214-3920
US

IV. Provider business mailing address

975 FLYNN RD
CAMARILLO CA
93012-8704
US

V. Phone/Fax

Practice location:
  • Phone: 805-231-2542
  • Fax:
Mailing address:
  • Phone: 805-231-2542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number43076
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: