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General NPI Number Information
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NPI Number | 1154785541
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Entity Type | Individual
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Provider Name | MONA MONZAVI DMD
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Gender | Female
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Dates
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Enumeration Date | 04/12/2016
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Last Update Date | 02/11/2022
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Provider Practice Location Address
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Address Line | 934 21ST ST APT 5
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City | SANTA MONICA
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State | CA
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Zip | 90403-3433
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Country | US
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Telephone | 805-679-1139
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Fax |
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Provider Business Mailing Address
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Address Line | 525 HIGH GROVE AVE
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City | GOLETA
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State | CA
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Zip | 93117-5543
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Country | US
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Telephone | 805-679-1139
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 63099
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License Number State | CA
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