Individual provider Active NPI

Marina Shehata

  • Dentist
  • Ventura, CA
National Provider Identifier
1730861329
Registry record updated Aug 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
109019 Issued in CA
Practice address
200 S Wells Rd Ste 100
Ventura, CA 93004-1378
Phone
(805) 647-6322
Fax
(805) 647-7164
NPI assigned
Aug 2, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 109019 CA Primary

Addresses

Primary practice location

200 S Wells Rd Ste 100
Ventura, CA 93004-1378

Mailing address

1040 Flynn Rd
Camarillo, CA 93012-5092
Phone (805) 673-3930

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20230816004291 CA Order and Referring Only - Other (Physician)Practitioner - Other (Physician) 2769844158

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
109019CAMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Clinicas del Camino Real Inc PastSince Aug 6, 2023 Accepting new patients
Clinicas del Camino Real Inc PastSince Aug 6, 2023 Accepting new patients
Clinicas del Camino Real Inc PastSince Aug 6, 2023 Accepting new patients
Clinicas del Camino Real Inc PastSince Aug 6, 2023 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: mshehata802678@direct.ochin.org
  • Direct secure messaging: marina.shehata.p1@direct.clinicas.nextgenshare.com

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1690934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690934400000",
    "number": "1730861329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1040 FLYNN RD",
            "city": "CAMARILLO",
            "state": "CA",
            "postal_code": "930125092",
            "telephone_number": "805-673-3930",
            "fax_number": "805-659-3217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 S WELLS RD STE 100",
            "city": "VENTURA",
            "state": "CA",
            "postal_code": "930041378",
            "telephone_number": "805-647-6322",
            "fax_number": "805-647-7164"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHEHATA",
        "first_name": "MARINA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-08-02",
        "last_updated": "2023-08-02",
        "certification_date": "2023-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "109019",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ventura, CA

Sources for this page

Verify at the official NPI Registry.