Rajeswari Challa, DDS
Individual provider Active NPI Dentist · Simi Valley, CA
NPI 1659828895 · NPPES record last updated Feb 6, 2025
Key facts
- NPI
- 1659828895
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 100792 (CA)
- Practice address
- 1755 Erringer Rd Ste 10
Simi Valley, CA 93065-6507 - Phone
- (805) 522-3100
- Fax
- (805) 522-3108
- NPI assigned
- Sep 6, 2016
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160914002296 | CA | Order and Referring Only - Dentist |
8325334501 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 100792 | CA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Clinicas del Camino Real Inc | Past | Accepting new patients | |
| Clinicas del Camino Real Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 100792 | CA | Yes |
Addresses
Primary practice location
1755 Erringer Rd Ste 10
Simi Valley, CA 93065-6507
Mailing address
1755 Erringer Rd Ste 10
Simi Valley, CA 93065-6507
Phone (805) 522-3100
Other providers in Simi Valley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 6, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.