Individual
JEIMA PATACSIL WACHOWIAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP, PHN, RN
Contact information
Practice address
1200 W GONZALES RD, SUITE 300, OXNARD, CA 93036-3072
(805) 983-0691
(805) 983-2026
Mailing address
1200 W GONZALES RD, SUITE 300, OXNARD, CA 93036-3072
(805) 983-0691
(805) 983-2026
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
524153
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
524153
—
CA
01
—
ZZZ34679Z
BLUE CROSS
CA
05
—
ZZZ75566Z
—
CA
Enumeration date
07/27/2006
Last updated
07/09/2007
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