Healthcare Provider Details

I. General information

NPI: 1790314888
Provider Name (Legal Business Name): MARIEL VILLAREAL FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 02/06/2026
Certification Date: 02/06/2026
Deactivation Date: 01/13/2026
Reactivation Date: 02/06/2026

III. Provider practice location address

3094 GERONIMO AVE
SIMI VALLEY CA
93063-5717
US

IV. Provider business mailing address

3094 GERONIMO AVE
SIMI VALLEY CA
93063-5717
US

V. Phone/Fax

Practice location:
  • Phone: 805-823-5901
  • Fax:
Mailing address:
  • Phone: 805-823-5901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95038205
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: