Healthcare Provider Details

I. General information

NPI: 1710457809
Provider Name (Legal Business Name): SHADI HEYDARI BATENI RADT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2018
Last Update Date: 11/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 N. VICTORIA AVENUE
OXNARD CA
93036
US

IV. Provider business mailing address

2150 N VICTORIA AVE
OXNARD CA
93036-7791
US

V. Phone/Fax

Practice location:
  • Phone: 805-382-6296
  • Fax:
Mailing address:
  • Phone: 805-382-6296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: