Healthcare Provider Details

I. General information

NPI: 1801540349
Provider Name (Legal Business Name): ANGELIA CORNELIUS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2022
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 W STANLEY AVE
VENTURA CA
93001-1313
US

IV. Provider business mailing address

1962 HARVEST LOOP
SANTA PAULA CA
93060-8007
US

V. Phone/Fax

Practice location:
  • Phone: 805-641-5000
  • Fax:
Mailing address:
  • Phone: 760-587-5275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number153899
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: