Healthcare Provider Details

I. General information

NPI: 1497922850
Provider Name (Legal Business Name): MARY ELIZABETH CANTRELL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARY ELIZABETH GREEN M.D.

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 05/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 HARBOR BLVD # 313
OXNARD CA
93035-4136
US

IV. Provider business mailing address

3600 HARBOR BLVD # 313
OXNARD CA
93035-4136
US

V. Phone/Fax

Practice location:
  • Phone: 805-815-4575
  • Fax: 805-204-4781
Mailing address:
  • Phone: 805-815-4575
  • Fax: 805-204-4781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberC43223
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: