Individual provider · Type 1 NPI

Mikey Thanteraphong

Nurse Practitioner · Simi Valley, CA

NPI number 1437795333 Active

Practice location

2845 Cochran St Ste B
Simi Valley, CA 93065-7905

Call (818) 835-7355 Map

Mailing address

PO Box 336
Agoura Hills, CA 91376-0336

Specialties and licenses

TaxonomyCodeLicense
Nurse Practitioner Primary 363L00000X95013063 (CA)

Nurse Practitioner: (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance wit…

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About NPI 1437795333

Mikey Thanteraphong's National Provider Identifier is 1437795333, issued on Nov 26, 2019. The primary taxonomy on file is Nurse Practitioner (363L00000X), and the practice location is in Simi Valley, CA. The record was last updated on Sep 25, 2025.