Healthcare Provider Details

I. General information

NPI: 1467981290
Provider Name (Legal Business Name): HOWELL HEALTHCARE TO, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2017
Last Update Date: 01/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 N MOORPARK RD STE 102-104
THOUSAND OAKS CA
91360-4405
US

IV. Provider business mailing address

PO BOX 539
MOORPARK CA
93020-0539
US

V. Phone/Fax

Practice location:
  • Phone: 805-371-4499
  • Fax: 805-371-4407
Mailing address:
  • Phone: 805-529-5370
  • Fax: 805-529-5397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MISS ERICA NACIN
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 805-529-5370