Healthcare Provider Details

I. General information

NPI: 1962873679
Provider Name (Legal Business Name): SARVENAZ BESHARAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2015
Last Update Date: 10/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 WILLIAMS DRIVE
OXNARD CA
93036
US

IV. Provider business mailing address

1800 FOURSITE LN APT #2
THOUSAND OAKS CA
91362-3053
US

V. Phone/Fax

Practice location:
  • Phone: 805-981-9200
  • Fax:
Mailing address:
  • Phone: 310-924-9224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberA02520315
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: