Pezhman Mansourian, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

47522 Issued in CA

Practice address

4015 Mission Oaks Blvd
Suite a
Camarillo, CA 93012-5156

Phone

(805) 987-2701

Fax

(805) 987-7092

NPI assigned

Jul 13, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1471219200000",
    "number": "1720003668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4015 MISSION OAKS BLVD",
            "address_2": "SUITE A",
            "city": "CAMARILLO",
            "state": "CA",
            "postal_code": "930125156",
            "telephone_number": "805-987-2701",
            "fax_number": "805-987-7092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4015 MISSION OAKS BLVD",
            "address_2": "SUITE A",
            "city": "CAMARILLO",
            "state": "CA",
            "postal_code": "930125156",
            "telephone_number": "805-987-2701",
            "fax_number": "805-987-7092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANSOURIAN",
        "first_name": "PEZHMAN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-13",
        "last_updated": "2016-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "47522",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Mangrum, BSN, RN
• Kaitlin Manker
• Ian Seth Mannarino
• Jessica Marie Manners
• Andrea Jean Manning, BA
• Dominique Mansur
• Khyle Rafael Manuel III
• Shawn Michele Manvell
• Mercedes Manzano, REGISTERED DIETITIAN
• Lorena Manzo

• Dentist in Camarillo, CA
• Providers in Camarillo, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.