Healthcare Provider Details

I. General information

NPI: 1710685565
Provider Name (Legal Business Name): ILISE ANN RIGNACK AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ILISE ANN KAPEN

II. Dates (important events)

Enumeration Date: 02/21/2023
Last Update Date: 02/21/2023
Certification Date: 02/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 WILLIAMS DR STE 150
OXNARD CA
93036-2612
US

IV. Provider business mailing address

2488 RUTLAND PL
THOUSAND OAKS CA
91362-1600
US

V. Phone/Fax

Practice location:
  • Phone: 805-981-8460
  • Fax:
Mailing address:
  • Phone: 310-367-5872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number137491
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: