Provider Demographics
NPI:1265738645
Name:UMAR GHAZALEH, IVONE
Entity type:Individual
Prefix:DR
First Name:IVONE
Middle Name:
Last Name:UMAR GHAZALEH
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 1:2530 ASHMORE CIR
Mailing Address - Street 2:APT. 28
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-5759
Mailing Address - Country:US
Mailing Address - Phone:805-570-3321
Mailing Address - Fax:
Practice Address - Street 1:2530 ASHMORE CIR
Practice Address - Street 2:APT. 28
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91362-5759
Practice Address - Country:US
Practice Address - Phone:805-570-3321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-02
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 27199103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical