Provider Demographics
NPI:1427658129
Name:BRONZAN, LINDA JANE
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:JANE
Last Name:BRONZAN
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 1:950 COUNTY SQUARE DR STE 112
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-5475
Mailing Address - Country:US
Mailing Address - Phone:805-407-6292
Mailing Address - Fax:
Practice Address - Street 1:950 COUNTY SQUARE DR STE 112
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-5475
Practice Address - Country:US
Practice Address - Phone:805-407-6292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-30
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA122463106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist