Healthcare Provider Details

I. General information

NPI: 1851062095
Provider Name (Legal Business Name): ASHLEY NERISSA MUNOZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2021
Last Update Date: 09/01/2023
Certification Date: 09/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2802 RIVERPARK BLVD
OXNARD CA
93036-5333
US

IV. Provider business mailing address

2802 RIVERPARK BLVD
OXNARD CA
93036-5333
US

V. Phone/Fax

Practice location:
  • Phone: 805-754-1607
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number62293
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: