Basic Information
| Provider Information | |||||||||
| NPI: | 1861741787 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VILLEGAS | ||||||||
| FirstName: | JEMELY | ||||||||
| MiddleName: | RAMOS | ||||||||
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| Credential: | N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1400 E CHURCH STREET | ||||||||
| Address2: | MEDICAL STAFF OFFICE | ||||||||
| City: | SANTA MARIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934545100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8057393114 | ||||||||
| FaxNumber: | 8057393502 | ||||||||
| Practice Location | |||||||||
| Address1: | 1304 ELLA ST STE A | ||||||||
| Address2: | |||||||||
| City: | SAN LUIS OBISPO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934014165 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8055499555 | ||||||||
| FaxNumber: | 8055490444 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2012 | ||||||||
| LastUpdateDate: | 07/31/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/31/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 21957 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 21957 | 01 | CA | NURSE PRACTITIONER LICENSE | OTHER | 503263 | 01 | CA | REGISTERED NURSE | OTHER | GU257Z | 01 | CA | MEDICARE PTAN | OTHER | 54018 | 01 | CA | PUBLIC HEALTH NURSING LICENSE | OTHER | F1112152 | 01 | CA | AMERICAN ACADEMY OF NURSE PRACTITIONERS | OTHER |