Healthcare Provider Details

I. General information

NPI: 1205783420
Provider Name (Legal Business Name): ELLEN G SEARLES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2026
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

543 COUNTRY CLUB DR STE B
SIMI VALLEY CA
93065-7696
US

IV. Provider business mailing address

1208 VILLAGE CT
SIMI VALLEY CA
93065-4312
US

V. Phone/Fax

Practice location:
  • Phone: 805-304-3563
  • Fax:
Mailing address:
  • Phone: 805-304-3563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberNP95038851
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: