Healthcare Provider Details

I. General information

NPI: 1083478796
Provider Name (Legal Business Name): EDENMAE CHU-PANGANIBAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2024
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 OUTLET CENTER DR
OXNARD CA
93036-0677
US

IV. Provider business mailing address

1200 W GONZALES RD
OXNARD CA
93036-3072
US

V. Phone/Fax

Practice location:
  • Phone: 805-983-8049
  • Fax: 805-983-8076
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95029438
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: