Provider Demographics
NPI:1508308941
Name:ENSIGN
Entity Type:Organization
Organization Name:ENSIGN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST ASSISTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:MONZON
Authorized Official - Suffix:I
Authorized Official - Credentials:PTA
Authorized Official - Phone:805-216-7633
Mailing Address - Street 1:680 CORTE REGALO
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-9107
Mailing Address - Country:US
Mailing Address - Phone:805-216-7633
Mailing Address - Fax:
Practice Address - Street 1:680 CORTE REGALO
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-9107
Practice Address - Country:US
Practice Address - Phone:805-216-7633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-16
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3736314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility