MEDICARE: COLLEEN MACIEL NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	95031099	CA

General Provider Information

NPI Number	:	1104777200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLLEEN MACIEL NP

Provider Business Mailing Address
First Line	:	441 CALLE CORAZON
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92057-8511
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	441 CALLE CORAZON
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92057-8511
Country	:	US
Telephone Number	:	760-496-8999
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/04/2026
Last Update Date	:	02/04/2026

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