MEDICARE: MARDLY PIERRE-JEROME

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	95034781	CA

General Provider Information

NPI Number	:	1770462541
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARDLY PIERRE-JEROME

Provider Business Mailing Address
First Line	:	2750 PARK VIEW CT STE 250
Second Line	:
City	:	OXNARD
State	:	CA
Zip	:	93036-5458
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2750 PARK VIEW CT
Second Line	:
City	:	OXNARD
State	:	CA
Zip	:	93036-5457
Country	:	US
Telephone Number	:	805-278-1688
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/27/2025
Last Update Date	:	08/27/2025

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Directions to “ MARDLY PIERRE-JEROME ” Practice Location

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