Healthcare Provider Details

I. General information

NPI: 1598575508
Provider Name (Legal Business Name): MICHELLE MARSZALEK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2025
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E DAILY DR STE 110
CAMARILLO CA
93010-5838
US

IV. Provider business mailing address

601 E DAILY DR STE 110
CAMARILLO CA
93010-5838
US

V. Phone/Fax

Practice location:
  • Phone: 805-485-5051
  • Fax: 805-278-7945
Mailing address:
  • Phone: 805-485-5051
  • Fax: 805-278-7945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95030194
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: