Healthcare Provider Details

I. General information

NPI: 1316360001
Provider Name (Legal Business Name): LILIA ARACELI ORTIZ ALCANTARA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2014
Last Update Date: 12/29/2021
Certification Date: 12/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 WILLIAMS DR # 150
OXNARD CA
93036-2612
US

IV. Provider business mailing address

3381 GLORIA DR
NEWBURY PARK CA
91320-2006
US

V. Phone/Fax

Practice location:
  • Phone: 805-981-8460
  • Fax: 805-981-8461
Mailing address:
  • Phone: 805-217-6019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT110570
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: