Healthcare Provider Details

I. General information

NPI: 1891968772
Provider Name (Legal Business Name): MANDANA ANOOSHEH ZOMORRODI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DONNA ANOOSHEH DDS

II. Dates (important events)

Enumeration Date: 04/11/2008
Last Update Date: 08/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3245 OLD CONEJO RD
NEWBURY PARK CA
91320-2152
US

IV. Provider business mailing address

3245 OLD CONEJO RD
NEWBURY PARK CA
91320-2152
US

V. Phone/Fax

Practice location:
  • Phone: 805-498-4400
  • Fax: 805-498-3510
Mailing address:
  • Phone: 805-498-4400
  • Fax: 805-498-3510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number35810
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: