Healthcare Provider Details

I. General information

NPI: 1639735780
Provider Name (Legal Business Name): TERA HELANA ROLFE ATC, LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2019
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W BARD RD
OXNARD CA
93033-6306
US

IV. Provider business mailing address

10612 VINCA LN APT 201
VENTURA CA
93004-4834
US

V. Phone/Fax

Practice location:
  • Phone: 805-607-4033
  • Fax: 602-294-5556
Mailing address:
  • Phone: 805-607-4033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberA160929395
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: