1033260682 NPI number — MRS. JENNIFER TOMIMITSU-CASEY BA AND ADS

Table of content: MRS. JENNIFER TOMIMITSU-CASEY BA AND ADS (NPI 1033260682)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033260682 NPI number — MRS. JENNIFER TOMIMITSU-CASEY BA AND ADS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TOMIMITSU-CASEY
Provider First Name:
JENNIFER
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
BA AND ADS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033260682
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/08/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2547 DUMETZ ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMARILLO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93010-6511
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-947-8767
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2055 SAVIERS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OXNARD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93033-3608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-483-2253
Provider Business Practice Location Address Fax Number:
805-483-2255
Provider Enumeration Date:
01/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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