Samuel Jefferson

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

1756 S Lewis Rd
Camarillo, CA 93012-8520

Phone

(805) 383-3669

NPI assigned

Dec 3, 2021

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Aspira Foster & Family Services - Ventura

  • Community/Behavioral Health Agency
  • Camarillo, CA
  • NPI 1215071899
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1638489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729728000000",
    "number": "1548928898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5284 ADOLFO RD STE 100",
            "city": "CAMARILLO",
            "state": "CA",
            "postal_code": "930126790",
            "telephone_number": "805-289-0120",
            "fax_number": "805-289-0130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1756 S LEWIS RD",
            "city": "CAMARILLO",
            "state": "CA",
            "postal_code": "930128520",
            "telephone_number": "805-383-3669"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5284 Adolfo Rd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Camarillo",
            "state": "CA",
            "postal_code": "930126790",
            "country_code": "US",
            "telephone_number": "805-289-0120",
            "fax_number": "805-289-0130",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JEFFERSON",
        "first_name": "SAMUEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-12-03",
        "last_updated": "2024-10-24",
        "certification_date": "2024-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ASPIRA",
            "identifier": "56CC",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cesar Jasso
• Guadalupe Jasso, MA
• Maria Guadalupe Jasso
• Elisa Jauregu
• Jeff Nicholl Physical Therapy & Sports Rehabilitation, Inc.
• Jeffrey Ballard, M.D., Apc
• Jennifer Bailey, Psy.D., a Psychological Corporation
• Jennifer Reinhardt Marriage and Family Therapy, Inc.
• Jensen Sports Chiropractic Inc.
• Karen Lynn Jensen-Vick, DPT, COMT

• Student in an Organized Health Care Education/Training Program in Camarillo, CA
• Providers in Camarillo, CA by specialty
• Student in an Organized Health Care Education/Training Program in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.