Provider Demographics
NPI:1104099092
Name:BERRY, MONICA VALERIA (LICENSED VOCATIONAL)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:VALERIA
Last Name:BERRY
Suffix:
Gender:F
Credentials:LICENSED VOCATIONAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:949 MCHUGH CT
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-5437
Mailing Address - Country:US
Mailing Address - Phone:805-861-6999
Mailing Address - Fax:
Practice Address - Street 1:2255 SAVIERS RD
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93033
Practice Address - Country:US
Practice Address - Phone:805-483-2253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN228603164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse