Provider Demographics
NPI:1558944397
Name:VILLEGAS, MARIAN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:MARIAN
Middle Name:
Last Name:VILLEGAS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 COMMONS PARK DR
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-7727
Mailing Address - Country:US
Mailing Address - Phone:806-773-0493
Mailing Address - Fax:
Practice Address - Street 1:320 COMMONS PARK DR
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-7727
Practice Address - Country:US
Practice Address - Phone:806-773-0493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95016020363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care