Healthcare Provider Details

I. General information

NPI: 1467828418
Provider Name (Legal Business Name): KRISTI GRIZARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2015
Last Update Date: 04/16/2021
Certification Date: 04/16/2021
Deactivation Date: 05/24/2016
Reactivation Date: 08/07/2017

III. Provider practice location address

260 MAPLE CT STE 205
VENTURA CA
93003-9134
US

IV. Provider business mailing address

260 MAPLE CT STE 205
VENTURA CA
93003-9134
US

V. Phone/Fax

Practice location:
  • Phone: 805-798-3723
  • Fax: 805-914-5552
Mailing address:
  • Phone: 805-798-3723
  • Fax: 805-914-5552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW99979
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: