Healthcare Provider Details

I. General information

NPI: 1255499497
Provider Name (Legal Business Name): ROUZBEH ZOKA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 06/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 LAS POSAS RD SUITE 212
CAMARILLO CA
93010-1427
US

IV. Provider business mailing address

3801 LAS POSAS RD SUITE 212
CAMARILLO CA
93010-1427
US

V. Phone/Fax

Practice location:
  • Phone: 805-482-6636
  • Fax:
Mailing address:
  • Phone: 805-482-6636
  • Fax: 805-482-0946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number39116
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: