Healthcare Provider Details

I. General information

NPI: 1619193208
Provider Name (Legal Business Name): NORMA ELISA AVINA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 W THOUSAND OAKS BLVD STE 300
THOUSAND OAKS CA
91360-4460
US

IV. Provider business mailing address

800 S VICTORIA AVE # L4640
VENTURA CA
93009-0002
US

V. Phone/Fax

Practice location:
  • Phone: 805-418-9100
  • Fax:
Mailing address:
  • Phone: 805-677-5146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number442850
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number8552
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: