Healthcare Provider Details

I. General information

NPI: 1851035919
Provider Name (Legal Business Name): MARK RYAN HERMANN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2022
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 N BRENT ST
VENTURA CA
93003-2854
US

IV. Provider business mailing address

147 N BRENT ST
VENTURA CA
93003-2809
US

V. Phone/Fax

Practice location:
  • Phone: 805-948-5011
  • Fax:
Mailing address:
  • Phone: 805-948-5011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA206399
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: