Healthcare Provider Details

I. General information

NPI: 1033544341
Provider Name (Legal Business Name): DANAE M WIBLE P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2013
Last Update Date: 04/23/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2241 WANKEL WAY STE C
OXNARD CA
93030-0191
US

IV. Provider business mailing address

2241 WANKEL WAY STE C
OXNARD CA
93030-0191
US

V. Phone/Fax

Practice location:
  • Phone: 805-983-0922
  • Fax:
Mailing address:
  • Phone: 805-351-8212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA23186
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: