Healthcare Provider Details

I. General information

NPI: 1740330810
Provider Name (Legal Business Name): PRASAD D. MUMMANENI, M.D.,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 N ROSE AVE STE 350
OXNARD CA
93030-3790
US

IV. Provider business mailing address

1700 N ROSE AVE STE 350
OXNARD CA
93030-3790
US

V. Phone/Fax

Practice location:
  • Phone: 805-983-0208
  • Fax: 805-981-0565
Mailing address:
  • Phone: 805-983-0208
  • Fax: 805-981-0565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA35782
License Number StateCA

VIII. Authorized Official

Name: MRS. DONNA SOUZA
Title or Position: OFFICE MANAGER
Credential:
Phone: 805-983-0208