Provider Demographics
NPI:1366808792
Name:IXTA, IGNACIO
Entity type:Individual
Prefix:
First Name:IGNACIO
Middle Name:
Last Name:IXTA
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 1:925 TAYLOR LN
Mailing Address - Street 2:
Mailing Address - City:FILLMORE
Mailing Address - State:CA
Mailing Address - Zip Code:93015-1056
Mailing Address - Country:US
Mailing Address - Phone:480-298-9040
Mailing Address - Fax:
Practice Address - Street 1:3101 S A ST
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93033-5211
Practice Address - Country:US
Practice Address - Phone:480-298-9040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-14
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health