Healthcare Provider Details

I. General information

NPI: 1790573822
Provider Name (Legal Business Name): AMBER LYNNE PERGESON PPS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2025
Last Update Date: 04/29/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 N JUANITA AVE
OXNARD CA
93030-3686
US

IV. Provider business mailing address

701 N JUANITA AVE
OXNARD CA
93030-3686
US

V. Phone/Fax

Practice location:
  • Phone: 805-385-1536
  • Fax:
Mailing address:
  • Phone: 805-385-1536
  • Fax: 805-981-1754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number210348038
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: