MEDICARE: MRS. RODREY ANNE MOZAKO-VILLA

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	363L00000X	Nurse Practitioner	11809	CA

General Provider Information

NPI Number	:	1780909044
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RODREY ANNE MOZAKO-VILLA

Provider Business Mailing Address
First Line	:	451 WEST GONZALEZ ROAD
Second Line	:	SUITE 260
City	:	OXNARD
State	:	CA
Zip	:	93036-0729
Country	:	US
Telephone Number	:	805-983-3557
Fax Number	:	805-983-2337

Provider Business Practice Location Address
First Line	:	451 WEST GONZALEZ ROAD
Second Line	:	SUITE 260
City	:	OXNARD
State	:	CA
Zip	:	93036-0729
Country	:	US
Telephone Number	:	805-983-3557
Fax Number	:	805-983-2337

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

Provider Enumeration Date	:	03/30/2010
Last Update Date	:	03/30/2010

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