Healthcare Provider Details

I. General information

NPI: 1508745233
Provider Name (Legal Business Name): ERIN DEMARS BAGNALL
Entity Type: Individual
Gender:
Sole Proprietor: N

Provider Other Name: ERIN SUMMER DEMARS BSN, RN

II. Dates (important events)

Enumeration Date: 08/27/2025
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1534 N. MOORPARK RD. PO BOX #256 PO BOX 256
THOUSAND OAKS CA
91360-5129
US

IV. Provider business mailing address

1534 N. MOORPARK RD. PO BOX #256 PO BOX 256
THOUSAND OAKS CA
91360-5129
US

V. Phone/Fax

Practice location:
  • Phone: 310-625-2257
  • Fax:
Mailing address:
  • Phone: 310-625-2257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95037402
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: