Healthcare Provider Details

I. General information

NPI: 1003477191
Provider Name (Legal Business Name): SHEILA GHANNADI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2019
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 N ASHWOOD AVE
VENTURA CA
93003-1810
US

IV. Provider business mailing address

120 N ASHWOOD AVE
VENTURA CA
93003-1810
US

V. Phone/Fax

Practice location:
  • Phone: 805-658-5800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA179076
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: