Basic Information
| Provider Information | |||||||||
| NPI: | 1104099092 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BERRY | ||||||||
| FirstName: | MONICA | ||||||||
| MiddleName: | VALERIA | ||||||||
| NamePrefix: | |||||||||
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| Credential: | LICENSED VOCATIONAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 949 MCHUGH CT | ||||||||
| Address2: | |||||||||
| City: | VENTURA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930035437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8058616999 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2255 SAVIERS RD | ||||||||
| Address2: | |||||||||
| City: | OXNARD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8054832253 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2008 | ||||||||
| LastUpdateDate: | 04/11/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164X00000X | VN228603 | CA | Y | Nursing Service Providers | Licensed Vocational Nurse |
No ID Information.