Healthcare Provider Details

I. General information

NPI: 1447032982
Provider Name (Legal Business Name): ALEJANDRA R KOEN CATC2 #2313869
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2023
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 WILLIAMS DR STE C
OXNARD CA
93036-2612
US

IV. Provider business mailing address

1911 WILLIAMS DR STE C
OXNARD CA
93036-2612
US

V. Phone/Fax

Practice location:
  • Phone: 820-426-0170
  • Fax:
Mailing address:
  • Phone: 820-426-0170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number2313869
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number2313869
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: