MEDICARE: DR. JEVON CHRIS MITSUOKA PHARM.D, PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	51802	CA
2	363AM0700X	Medical Physician Assistant	17474	CA
3	363A00000X	Physician Assistant	17474	CA

General Provider Information

NPI Number	:	1215928171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEVON CHRIS MITSUOKA PHARM.D, PA-C

Provider Business Mailing Address
First Line	:	5725 RALSTON ST STE 101
Second Line	:
City	:	VENTURA
State	:	CA
Zip	:	93003-6053
Country	:	US
Telephone Number	:	661-775-7737
Fax Number	:

Provider Business Practice Location Address
First Line	:	29351 MADEIRA LN
Second Line	:
City	:	VALENCIA
State	:	CA
Zip	:	91354-1598
Country	:	US
Telephone Number	:	661-775-7737
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2005
Last Update Date	:	08/22/2025

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