Provider Demographics
NPI:1487432431
Name:PANCRATZ, AUSTIN JACOB
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:JACOB
Last Name:PANCRATZ
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 1:1856 RIBERA DR
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-5442
Mailing Address - Country:US
Mailing Address - Phone:253-831-8088
Mailing Address - Fax:
Practice Address - Street 1:2130 N VENTURA RD
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-2246
Practice Address - Country:US
Practice Address - Phone:805-289-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-20
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 172V00000X
CA373H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No172V00000XOther Service ProvidersCommunity Health Worker