Healthcare Provider Details

I. General information

NPI: 1154531143
Provider Name (Legal Business Name): GLORIA AMBRIZ REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 08/19/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 WILLIAMS DR #120
OXNARD CA
93036-2612
US

IV. Provider business mailing address

1911 WILLIAMS DR #120
OXNARD CA
93036-2612
US

V. Phone/Fax

Practice location:
  • Phone: 805-981-9243
  • Fax:
Mailing address:
  • Phone: 805-981-9243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number541354
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number541354
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: