Mojan R Deriss, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA60028 Issued in CA

Practice address

32144 Agoura Rd Ste 106
Westlake Village, CA 91361-4040

Phone

(805) 379-3376

Fax

(805) 379-3267

NPI assigned

Mar 20, 2019

Reactivated

Apr 28, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Daphne I Panagotacos MD

  • Dermatopathology Physician
  • Westlake Village, CA
  • NPI 1295999274

  Single Specialty

  NPD
• Daphne I Panagotacos MD

  • Specialist
  • Westlake Village, CA
  • NPI 1740378280

  Single Specialty

  NPD (past)

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

{
    "created_epoch": "1553040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694044800000",
    "number": "1740740372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "32144 AGOURA RD STE 106",
            "city": "WESTLAKE VILLAGE",
            "state": "CA",
            "postal_code": "913614040",
            "telephone_number": "805-214-1012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "32144 AGOURA RD STE 106",
            "city": "WESTLAKE VILLAGE",
            "state": "CA",
            "postal_code": "913614040",
            "telephone_number": "805-379-3376",
            "fax_number": "805-379-3267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERISS",
        "first_name": "MOJAN",
        "middle_name": "R",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-03-20",
        "last_updated": "2023-09-07",
        "certification_date": "2022-01-15",
        "deactivation_date": "2020-05-22",
        "reactivation_date": "2021-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CA",
            "license": "PA60028",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA60028",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lauren Dela Victoria
• Darionne D Delpino, AMFT, APCC
• Scott Tyler Demar, CRNA
• Dencher Inc.
• Patti Diane Dengler, MS, LMFT
• Dermatology Associates of Westlake
• Sophia Karina Dervi
• Mary Lou Devlin, LMFT
• Katherine Di Domenico, NP
• Jessica Emily Di Lucchio, D.C.

• Physician Assistant in Westlake Village, CA
• Providers in Westlake Village, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.