Healthcare Provider Details

I. General information

NPI: 1205360997
Provider Name (Legal Business Name): CALIFORNIA RN FIRST ASSISTANT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2017
Last Update Date: 04/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 N BRENT ST
VENTURA CA
93003-2809
US

IV. Provider business mailing address

1290 SUNNYCREST AVE
VENTURA CA
93003-1213
US

V. Phone/Fax

Practice location:
  • Phone: 805-766-3505
  • Fax: 480-545-2673
Mailing address:
  • Phone: 805-766-3505
  • Fax: 480-545-2673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number544146
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number95000716
License Number StateCA

VIII. Authorized Official

Name: SUSAN RONEY HIBBERD
Title or Position: MANAGER
Credential: NP
Phone: 805-766-3505