Provider Demographics
NPI:1215701867
Name:SCRIBNER, STORMY
Entity type:Individual
Prefix:
First Name:STORMY
Middle Name:
Last Name:SCRIBNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3653 TEXAS AVE
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-1424
Mailing Address - Country:US
Mailing Address - Phone:805-832-1041
Mailing Address - Fax:
Practice Address - Street 1:530 NEW LOS ANGELES AVE STE 105B
Practice Address - Street 2:
Practice Address - City:MOORPARK
Practice Address - State:CA
Practice Address - Zip Code:93021-2078
Practice Address - Country:US
Practice Address - Phone:805-531-9275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA78800225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist