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1790314888 NPI number — MARIEL VILLAREAL FNP-BC

NPI Number: 1790314888
Health Care Provider/Practitioner: MARIEL VILLAREAL FNP-BC

Information about “1790314888” NPI (MARIEL VILLAREAL FNP-BC) exists in 1790314888 in HTML format HTML  |  1790314888 in plain Text format TXT  |  1790314888 in PDF (Portable Document Format) PDF  |  1790314888 in an XML format XML  formats.

NPI Number : 1790314888 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1790314888",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "VILLAREAL",
    "FirstName": "MARIEL",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "FNP-BC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3094 GERONIMO AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SIMI VALLEY",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "93063-5717",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "805-823-5901",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "3094 GERONIMO AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SIMI VALLEY",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "93063-5717",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "805-823-5901",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/02/2020",
    "LastUpdateDate": "02/06/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": "01/13/2026",
    "NPIReactivationDate": "02/06/2026",
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363LF0000X",
        "TaxonomyName": "Family Nurse Practitioner",
        "LicenseNumber": "NP95038205",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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