Healthcare Provider Details

I. General information

NPI: 1306248893
Provider Name (Legal Business Name): MONA HERAVI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2014
Last Update Date: 12/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 N VENTURA RD STE 2
OXNARD CA
93030-3836
US

IV. Provider business mailing address

1040 FLYNN RD
CAMARILLO CA
93012-5092
US

V. Phone/Fax

Practice location:
  • Phone: 805-751-4765
  • Fax: 805-988-0554
Mailing address:
  • Phone: 805-673-3930
  • Fax: 805-659-3217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number63844
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: