MEDICARE: MONA MONZAVI DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0300X	Periodontics	63099	CA

General Provider Information

NPI Number	:	1154785541
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONA MONZAVI DMD

Provider Business Mailing Address
First Line	:	525 HIGH GROVE AVE
Second Line	:
City	:	GOLETA
State	:	CA
Zip	:	93117-5543
Country	:	US
Telephone Number	:	805-679-1139
Fax Number	:

Provider Business Practice Location Address
First Line	:	934 21ST ST APT 5
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-3433
Country	:	US
Telephone Number	:	805-679-1139
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2016
Last Update Date	:	02/11/2022

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