Healthcare Provider Details

I. General information

NPI: 1841299286
Provider Name (Legal Business Name): SIMI VALLEY THERAPIES WEST, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4080 LOMA VISTA RD
VENTURA CA
93003
US

IV. Provider business mailing address

1390 SORREL ST
SIMI VALLEY CA
93065-3357
US

V. Phone/Fax

Practice location:
  • Phone: 805-535-4400
  • Fax:
Mailing address:
  • Phone: 805-207-6808
  • Fax: 805-522-1009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT21563
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number21563
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. DEBORAH ILENE ELMORE-DION
Title or Position: OWNER
Credential:
Phone: 805-207-6808