Healthcare Provider Details

I. General information

NPI: 1407379647
Provider Name (Legal Business Name): KIERSTIN ROSE SANCHEZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIERSTIN ROSE GIER LCSW

II. Dates (important events)

Enumeration Date: 07/19/2017
Last Update Date: 11/13/2023
Certification Date: 09/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2240 E GONZALES RD STE 110
OXNARD CA
93036-8212
US

IV. Provider business mailing address

5740 RALSTON ST STE 100
VENTURA CA
93003-7847
US

V. Phone/Fax

Practice location:
  • Phone: 805-961-5161
  • Fax:
Mailing address:
  • Phone: 805-289-3100
  • Fax: 805-289-3395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number103505
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: