Healthcare Provider Details

I. General information

NPI: 1881018604
Provider Name (Legal Business Name): MARIA CARIDAD VILLAREAL CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2014
Last Update Date: 02/14/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 X ST
SACRAMENTO CA
95817-2214
US

IV. Provider business mailing address

3017 DOVEHOUSE CT
MODESTO CA
95355-8690
US

V. Phone/Fax

Practice location:
  • Phone: 800-282-3284
  • Fax:
Mailing address:
  • Phone: 209-846-9936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number95000039
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: