Healthcare Provider Details

I. General information

NPI: 1649009986
Provider Name (Legal Business Name): MARIANA ALAMILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2024
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 SANTA MARIA WAY
SANTA MARIA CA
93455-2118
US

IV. Provider business mailing address

2050 S BLOSSER RD
SANTA MARIA CA
93458-7310
US

V. Phone/Fax

Practice location:
  • Phone: 805-934-5400
  • Fax: 805-938-9207
Mailing address:
  • Phone: 805-361-8030
  • Fax: 805-361-8097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA66745
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: