Provider Demographics
NPI:1275627358
Name:DEPRISCO, JOANNE (PA)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:DEPRISCO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3247 GINKO CT
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-2818
Mailing Address - Country:US
Mailing Address - Phone:805-241-6255
Mailing Address - Fax:
Practice Address - Street 1:1851 LOMBARD ST
Practice Address - Street 2:#100
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-8230
Practice Address - Country:US
Practice Address - Phone:805-983-2234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17126363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant