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General NPI Number Information
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NPI Number | 1417467648
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Entity Type | Individual
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Provider Name | JASMINE ALYSE ANGUIANO ATC
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Gender | Female
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Dates
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Enumeration Date | 10/02/2017
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Last Update Date | 10/02/2017
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Provider Practice Location Address
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Address Line | 545 CENTRAL AVE
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City | OXNARD
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State | CA
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Zip | 93036-1045
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Country | US
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Telephone | 805-278-5500
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Fax |
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Provider Business Mailing Address
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Address Line | 2201 LAVANDA DR
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City | OXNARD
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State | CA
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Zip | 93036-2509
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Country | US
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Telephone | 805-889-2028
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2000022826
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License Number State | CA
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