Healthcare Provider Details

I. General information

NPI: 1548902059
Provider Name (Legal Business Name): DOROTHY M GRIMES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2022
Last Update Date: 04/13/2022
Certification Date: 04/13/2022
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: 805-385-9460
  • Fax:
Mailing address:
  • Phone: 805-385-9460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN95235092
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: