1295800308 NPI number — CALIFORNIA CARDIOVASCULAR AND THORACIC SURGEONS

Table of content: (NPI 1295800308)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295800308 NPI number — CALIFORNIA CARDIOVASCULAR AND THORACIC SURGEONS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CALIFORNIA CARDIOVASCULAR AND THORACIC SURGEONS
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:
6
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:
1295800308
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/24/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
168 N BRENT ST
Provider Second Line Business Mailing Address:
SUITE 508
Provider Business Mailing Address City Name:
VENTURA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93003-2817
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-643-2375
Provider Business Mailing Address Fax Number:
805-643-3511

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
168 N BRENT ST
Provider Second Line Business Practice Location Address:
SUITE 508
Provider Business Practice Location Address City Name:
VENTURA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93003-2817
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-643-2375
Provider Business Practice Location Address Fax Number:
805-643-3511
Provider Enumeration Date:
11/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BUSHNELL
Authorized Official First Name:
LAMAR
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
805-643-2375

Provider Taxonomy Codes

  • Taxonomy code: 2086S0129X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com