Healthcare Provider Details

I. General information

NPI: 1699869412
Provider Name (Legal Business Name): MONISHA RAO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2438 PONDEROSA DRIVE NORTH SUITE NUMBER C209
CAMARILLO CA
93012
US

IV. Provider business mailing address

4668 PASEO MARAVILLA
CAMARILLO CA
93012-4001
US

V. Phone/Fax

Practice location:
  • Phone: 805-482-0721
  • Fax:
Mailing address:
  • Phone: 805-384-2309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA72862
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: