Provider Demographics
NPI:1790314888
Name:VILLAREAL, MARIEL (RN)
Entity Type:Individual
Prefix:
First Name:MARIEL
Middle Name:
Last Name:VILLAREAL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2229 KNOLLHAVEN ST
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-2526
Mailing Address - Country:US
Mailing Address - Phone:805-823-5901
Mailing Address - Fax:
Practice Address - Street 1:1400 EASTON DR STE 147B
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-9406
Practice Address - Country:US
Practice Address - Phone:805-823-5901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-02
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based