Healthcare Provider Details

I. General information

NPI: 1679405229
Provider Name (Legal Business Name): BRINIDEY YVONNE WILLSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 N ROSE AVE
OXNARD CA
93030-3722
US

IV. Provider business mailing address

3827 LUPINE LN APT P
CALABASAS CA
91302-2923
US

V. Phone/Fax

Practice location:
  • Phone: 805-988-2500
  • Fax:
Mailing address:
  • Phone: 580-548-7574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM1400X
TaxonomyNurse Massage Therapist (NMT)
License Number95417942
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: