Healthcare Provider Details

I. General information

NPI: 1194642199
Provider Name (Legal Business Name): THOMAS OUTLAW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 WILLIAMS DR STE 200
OXNARD CA
93036-0673
US

IV. Provider business mailing address

1971 EL DORADO AVE
OXNARD CA
93033-2003
US

V. Phone/Fax

Practice location:
  • Phone: 866-998-2243
  • Fax:
Mailing address:
  • Phone: 805-868-9892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: