Healthcare Provider Details

I. General information

NPI: 1912361676
Provider Name (Legal Business Name): AMY LARAYNE WARD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2016
Last Update Date: 04/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 W HILLCREST DR
THOUSAND OAKS CA
91320-2734
US

IV. Provider business mailing address

518 GARDEN ST
SANTA BARBARA CA
93101-1606
US

V. Phone/Fax

Practice location:
  • Phone: 888-898-3806
  • Fax: 805-498-6469
Mailing address:
  • Phone: 805-963-2445
  • Fax: 805-965-2292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number829032
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: