Healthcare Provider Details

I. General information

NPI: 1679905830
Provider Name (Legal Business Name): WENDY HIPPLE M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: WENDY RIOS MA

II. Dates (important events)

Enumeration Date: 07/30/2013
Last Update Date: 06/16/2021
Certification Date: 06/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 WILLIAMS DR
OXNARD CA
93036-2612
US

IV. Provider business mailing address

1911 WILLIAMS DR STE 165
OXNARD CA
93036-2612
US

V. Phone/Fax

Practice location:
  • Phone: 805-981-4233
  • Fax: 805-981-9268
Mailing address:
  • Phone: 805-981-4233
  • Fax: 805-981-9268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT105344
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: