Healthcare Provider Details

I. General information

NPI: 1720482110
Provider Name (Legal Business Name): MARYAM ATASHBAR NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2014
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 WILLIAMS DR STE 200
OXNARD CA
93036-0673
US

IV. Provider business mailing address

1911 WILLIAMS DR STE 200
OXNARD CA
93036-0673
US

V. Phone/Fax

Practice location:
  • Phone: 805-981-6830
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number746767
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95007680
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: