Healthcare Provider Details

I. General information

NPI: 1225684566
Provider Name (Legal Business Name): MARITONI TIZON-DAMIANO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2019
Last Update Date: 03/11/2023
Certification Date: 03/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1429 E THOUSAND OAKS BLVD STE 100
THOUSAND OAKS CA
91362-6228
US

IV. Provider business mailing address

1429 E THOUSAND OAKS BLVD STE 100
THOUSAND OAKS CA
91362-6228
US

V. Phone/Fax

Practice location:
  • Phone: 805-906-2015
  • Fax:
Mailing address:
  • Phone: 805-906-2015
  • Fax: 805-953-8347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95012053
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: