Healthcare Provider Details

I. General information

NPI: 1336684620
Provider Name (Legal Business Name): PATRICIA EBNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2016
Last Update Date: 02/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 S C ST
OXNARD CA
93033-4560
US

IV. Provider business mailing address

2500 S C ST
OXNARD CA
93033-4560
US

V. Phone/Fax

Practice location:
  • Phone: 805-385-9420
  • Fax:
Mailing address:
  • Phone: 805-385-9401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number104724
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: