Healthcare Provider Details

I. General information

NPI: 1063352219
Provider Name (Legal Business Name): SHANA DANBI BLAIR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

488 MARKET ST
VENTURA CA
93003
US

IV. Provider business mailing address

488 MARKET ST
VENTURA CA
93003
US

V. Phone/Fax

Practice location:
  • Phone: 805-212-4072
  • Fax: 805-843-1612
Mailing address:
  • Phone: 805-212-4072
  • Fax: 805-843-1612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: