Active NPI
Mina Goudarzi
- Dentist
- Oxnard, CA
National Provider Identifier
1821913625
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 113619
- Practice address
- 2100 Statham Blvd
Oxnard, CA 93033 - Phone
- (805) 330-8682
- Fax
- (805) 728-1433
- NPI assigned
- Aug 11, 2026
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 113619 | CA | Primary |
Addresses
Primary practice location
2100 Statham Blvd
Oxnard, CA 93033
Mailing address
1040 Flynn Rd
Camarillo, CA 93012-8705
Phone (805) 673-3930
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1786406400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1786579200000",
"number": "1821913625",
"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": "930128705",
"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": "2100 STATHAM BLVD",
"city": "OXNARD",
"state": "CA",
"postal_code": "93033",
"telephone_number": "805-330-8682",
"fax_number": "805-728-1433"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOUDARZI",
"first_name": "MINA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2026-08-11",
"last_updated": "2026-08-13",
"certification_date": "2026-08-13",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "113619",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oxnard, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2026; 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.