Individual
CATHRYN DIANE INGRAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
138 W MAIN ST, SUITE E, F, G, VENTURA, CA 93001-2584
(805) 667-2850
Mailing address
5855 OLIVAS PARK DR, VENTURA, CA 93003-7672
(805) 667-2801
(805) 667-2865
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
PA13939
CA
363LF0000X
Family Nurse Practitioner
Primary
RN CA326459, NP8826
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
95-1683892
OTHER INSURANCE
CA
05
—
RHM08608F
—
CA
05
—
RHM08609F
—
CA
05
—
RHM18553H
—
CA
05
—
ZZT40394F
—
CA
Enumeration date
06/01/2005
Last updated
12/26/2013
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