Healthcare Provider Details

I. General information

NPI: 1588405948
Provider Name (Legal Business Name): NALLELI ALFARO MALDONADO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2024
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2772 JOHNSON DR STE 200
VENTURA CA
93003-7262
US

IV. Provider business mailing address

2772 JOHNSON DR STE 200
VENTURA CA
93003-7262
US

V. Phone/Fax

Practice location:
  • Phone: 805-642-1430
  • Fax: 833-916-2135
Mailing address:
  • Phone: 805-642-1430
  • Fax: 833-916-2135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95030172
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: