Healthcare Provider Details

I. General information

NPI: 1164761797
Provider Name (Legal Business Name): ANGELA MONTGOMERY TIMMONS DPA, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2013
Last Update Date: 01/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1429 W ELM ST
OXNARD CA
93033-3059
US

IV. Provider business mailing address

1429 W. ELM STREET
OXNARD CA
93033
US

V. Phone/Fax

Practice location:
  • Phone: 805-479-7840
  • Fax:
Mailing address:
  • Phone: 805-479-7840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number18452
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: