Healthcare Provider Details

I. General information

NPI: 1538207774
Provider Name (Legal Business Name): SHARON PETIT CUMMINGS RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1247 WESTRIDGE DR
VENTURA CA
93003-1457
US

IV. Provider business mailing address

1247 WESTRIDGE DR
VENTURA CA
93003-1457
US

V. Phone/Fax

Practice location:
  • Phone: 805-650-3476
  • Fax: 805-650-3476
Mailing address:
  • Phone: 805-650-3476
  • Fax: 805-650-3476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN 377135
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: