Healthcare Provider Details

I. General information

NPI: 1649022112
Provider Name (Legal Business Name): MIXTECO/INDIGENA COMMUNITY ORGANIZING PROJECT(MICOP)
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2024
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 MAGNOLIA AVE
OXNARD CA
93030-5336
US

IV. Provider business mailing address

PO BOX 20543
OXNARD CA
93034-0543
US

V. Phone/Fax

Practice location:
  • Phone: 805-483-1166
  • Fax:
Mailing address:
  • Phone: 805-274-1188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name: ANA HUYNH
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 805-940-5526