Healthcare Provider Details

I. General information

NPI: 1659828895
Provider Name (Legal Business Name): RAJESWARI CHALLA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2016
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 ERRINGER RD STE 10
SIMI VALLEY CA
93065-6507
US

IV. Provider business mailing address

1755 ERRINGER RD STE 10
SIMI VALLEY CA
93065-6507
US

V. Phone/Fax

Practice location:
  • Phone: 805-522-3100
  • Fax: 805-522-3108
Mailing address:
  • Phone: 805-522-3100
  • Fax: 805-522-3108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number100792
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: