Healthcare Provider Details

I. General information

NPI: 1386357085
Provider Name (Legal Business Name): MISS JAYNE MISLANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2022
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 S C ST STE D
OXNARD CA
93033-4574
US

IV. Provider business mailing address

2500 S C ST STE D
OXNARD CA
93033-4574
US

V. Phone/Fax

Practice location:
  • Phone: 805-385-9460
  • Fax: 805-385-9407
Mailing address:
  • Phone: 805-859-4603
  • Fax: 805-385-9407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number349320
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: