Healthcare Provider Details

I. General information

NPI: 1396955704
Provider Name (Legal Business Name): DALE A. HEWLETT LICENSED PSYCH TECH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HILLMONT AVE
VENTURA CA
93003-1651
US

IV. Provider business mailing address

1753 LAS POSAS RD
CAMARILLO CA
93010-3108
US

V. Phone/Fax

Practice location:
  • Phone: 805-652-6727
  • Fax:
Mailing address:
  • Phone: 805-987-8344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License Number22961
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: