Healthcare Provider Details

I. General information

NPI: 1104777200
Provider Name (Legal Business Name): COLLEEN MACIEL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COLLEEN DUCKWORTH

II. Dates (important events)

Enumeration Date: 02/04/2026
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25405 HANCOCK AVE STE 105
MURRIETA CA
92562-5978
US

IV. Provider business mailing address

441 CALLE CORAZON
OCEANSIDE CA
92057-8511
US

V. Phone/Fax

Practice location:
  • Phone: 951-695-4688
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95031099
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: