Healthcare Provider Details

I. General information

NPI: 1750166302
Provider Name (Legal Business Name): JACK CHRISTOPHER ARNOLD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2023
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4333 E VINEYARD AVE
OXNARD CA
93036-1013
US

IV. Provider business mailing address

880 W HIGHLAND DR
CAMARILLO CA
93010-1139
US

V. Phone/Fax

Practice location:
  • Phone: 805-981-5572
  • Fax:
Mailing address:
  • Phone: 805-501-0182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number136521
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: