Healthcare Provider Details

I. General information

NPI: 1780704411
Provider Name (Legal Business Name): JULISSA B NOBLE CAODC-A-CS,LAADC-CA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULISSA B. NOBLE 7169,LCI2840818

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 04/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 SAVIERS RD
OXNARD CA
93033-3608
US

IV. Provider business mailing address

2591 OUTLOOK CV
PORT HUENEME CA
93041-1566
US

V. Phone/Fax

Practice location:
  • Phone: 805-483-2253
  • Fax:
Mailing address:
  • Phone: 619-779-9122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1612
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: