Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
MOJAN R DERISS, PA-C
Deactivated Sole ProprietorMOJAN R DERISS, PA-C is a Physician Assistant healthcare provider located in WESTLAKE VILLAGE, California. NPI 1740740372 is deactivated in the NPPES registry. Verify at CMS.
Physician Assistant · WESTLAKE VILLAGE, CA
This NPI has been deactivated.
The record was deactivated on May 22, 2020.
Deactivated NPIs are no longer valid for billing or credentialing. The provider may have retired, changed practice status, or had their NPI administratively deactivated.
Verify current licensure status with the NPPES NPI Registry or the relevant state medical board before relying on this record.
Registration Details
- NPI Number
- 1740740372
- Provider Type
- Individual
- Gender
- Female
- NPI Issued
- Mar 20, 2019 (1.172602739726 yrs)
- Last Updated
- Sep 7, 2023
- Deactivated
- May 22, 2020
- Licenses
-
PA60028 (CA)PA60028 (CA)
- Sole Proprietor
- Yes
Practice Information
- Address
-
32144 AGOURA RD STE 106WESTLAKE VILLAGE, CA, 913614040Browse CA providers · Browse ZIP 91361
- Phone
- 8053793376
- Fax
- 8053793267
- Primary Specialty
-
Physician Assistant
363A00000X
- Additional Specialty
- Dermatology
- Additional Specialty
- Physician Assistant
Other Physician Assistant Providers in WESTLAKE VILLAGE, CA
| Name | Credential | NPI |
|---|---|---|
| DEALIE ELIZABETH PARK | PA | 1427161488 |
| SHERRI N ANDERSON | PA | 1366611774 |
| MRS. JOHANNA BULMER | P.A. | 1518126804 |
| MS. KRISTIN NICOLE RUPERT | PA-C | 1871802389 |
| HEATHER LINDSEY MCDANIEL | P,A | 1619252913 |
| ERIN BROOKE CALL | MSPAS, PA-C | 1164770962 |
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.