Healthcare Provider Details

I. General information

NPI: 1700778370
Provider Name (Legal Business Name): JOEL ACKERSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2025
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 WILLIAMS DR STE 200
OXNARD CA
93036-0673
US

IV. Provider business mailing address

1911 WILLIAMS DR STE 200
OXNARD CA
93036-0673
US

V. Phone/Fax

Practice location:
  • Phone: 866-998-2243
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN95186732
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: