Healthcare Provider Details

I. General information

NPI: 1376458851
Provider Name (Legal Business Name): MARIEL BUENAFLOR NGUYEN LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 YULUPA AVE
SANTA ROSA CA
95405-7020
US

IV. Provider business mailing address

1961 BLUE SKY LN
SANTA ROSA CA
95407-4543
US

V. Phone/Fax

Practice location:
  • Phone: 707-542-7375
  • Fax:
Mailing address:
  • Phone: 707-237-1091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number287869
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: