Provider Demographics
NPI:1851776199
Name:ORNELAS, JESUS
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:
Last Name:ORNELAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2790 MCCULLOCH ST
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-6530
Mailing Address - Country:US
Mailing Address - Phone:805-982-0135
Mailing Address - Fax:
Practice Address - Street 1:1911 WILLIAMS DR STE 110
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-2665
Practice Address - Country:US
Practice Address - Phone:805-981-4200
Practice Address - Fax:805-981-3341
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-28
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CAR1329991118101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health