1003216276 NPI number — ROLLING OAKS SURGERY CENTER LLC

Table of content: (NPI 1003216276)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003216276 NPI number — ROLLING OAKS SURGERY CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROLLING OAKS SURGERY CENTER LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003216276
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/20/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
425 HAALAND DR
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
THOUSAND OAKS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91361-5229
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-373-7073
Provider Business Mailing Address Fax Number:
805-373-1116

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
415 ROLLING OAKS DR
Provider Second Line Business Practice Location Address:
SUITE 115
Provider Business Practice Location Address City Name:
THOUSAND OAKS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91361-1029
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-373-7073
Provider Business Practice Location Address Fax Number:
805-373-1116
Provider Enumeration Date:
08/25/2014

Additional Information

Authorized Official

Authorized Official Last Name:
AZAR
Authorized Official First Name:
KOUROS
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
805-373-7073

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  A79029 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com