Healthcare Provider Details

I. General information

NPI: 1477641546
Provider Name (Legal Business Name): JOYCELYN VIDAL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 05/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 RALSTON STREET
VENTURA CA
93003
US

IV. Provider business mailing address

5400 RALSTON STREET
VENTURA CA
93003
US

V. Phone/Fax

Practice location:
  • Phone: 805-963-2445
  • Fax: 805-965-6981
Mailing address:
  • Phone: 805-963-2445
  • Fax: 805-965-6981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number13163
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number594657
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: