Provider Demographics
NPI:1821167214
Name:MARIN, VENUS MACIAS (NP(NURSE PRACTITIONE)
Entity Type:Individual
Prefix:MRS
First Name:VENUS
Middle Name:MACIAS
Last Name:MARIN
Suffix:
Gender:F
Credentials:NP(NURSE PRACTITIONE
Other - Prefix:
Other - First Name:VENUS
Other - Middle Name:MACIAS
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP(NURSE PRACTITIONE
Mailing Address - Street 1:2211 PONDEROSA ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-7931
Mailing Address - Country:US
Mailing Address - Phone:714-550-9789
Mailing Address - Fax:
Practice Address - Street 1:3130 S HARBOR BLVD
Practice Address - Street 2:250
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-6824
Practice Address - Country:US
Practice Address - Phone:714-619-8777
Practice Address - Fax:714-619-8770
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16914363LF0000X
CA584175363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA584175OtherRN