Healthcare Provider Details

I. General information

NPI: 1255139622
Provider Name (Legal Business Name): REGINA CUNNINGHAM RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2025
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HILLMONT AVE
VENTURA CA
93003-1651
US

IV. Provider business mailing address

2817 SMOKEY MOUNTAIN DR
OXNARD CA
93036-5342
US

V. Phone/Fax

Practice location:
  • Phone: 805-652-6237
  • Fax:
Mailing address:
  • Phone: 805-889-8542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number95095127
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: