Healthcare Provider Details

I. General information

NPI: 1578331369
Provider Name (Legal Business Name): REGINA DAQUILLA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2023
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 W MAIN ST STE B
VENTURA CA
93001-4501
US

IV. Provider business mailing address

252 FRASER LN
VENTURA CA
93001-1108
US

V. Phone/Fax

Practice location:
  • Phone: 805-906-1382
  • Fax:
Mailing address:
  • Phone: 805-906-1382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95028138
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: