Provider Demographics
NPI:1841601689
Name:PLEASANT VALLEY FAMILYDENTAL
Entity Type:Organization
Organization Name:PLEASANT VALLEY FAMILYDENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REZA
Authorized Official - Middle Name:
Authorized Official - Last Name:KARIMI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-483-0421
Mailing Address - Street 1:4938 S C ST
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93033-7504
Mailing Address - Country:US
Mailing Address - Phone:805-483-0421
Mailing Address - Fax:
Practice Address - Street 1:4938 S C ST
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93033-7504
Practice Address - Country:US
Practice Address - Phone:805-483-0421
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-14
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35918261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1538207907OtherNPI
CAD35918OtherRENDERING PROVIDER
CAG9062602Medicaid