Healthcare Provider Details

I. General information

NPI: 1932551785
Provider Name (Legal Business Name): ANDREW SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2016
Last Update Date: 05/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 SAVIERS RD STE A
OXNARD CA
93033-3608
US

IV. Provider business mailing address

119 FIGUEROA ST
VENTURA CA
93001-2756
US

V. Phone/Fax

Practice location:
  • Phone: 805-483-2253
  • Fax:
Mailing address:
  • Phone: 805-419-0156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number93324
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: