1316976327 NPI number — CALIFORNIA CENTER FOR CARDIOTHORACIC SURGERY

Table of content: ELAINE TEOLOGO LVN, CMT, LAC (NPI 1801217195)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316976327 NPI number — CALIFORNIA CENTER FOR CARDIOTHORACIC SURGERY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CALIFORNIA CENTER FOR CARDIOTHORACIC SURGERY
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:
1316976327
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2190 LYNN RD
Provider Second Line Business Mailing Address:
SUITE 220
Provider Business Mailing Address City Name:
THOUSAND OAKS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91360
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-495-8050
Provider Business Mailing Address Fax Number:
805-496-2160

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2100 LYNN RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
THOUSAND OAKS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91360
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-379-9456
Provider Business Practice Location Address Fax Number:
805-494-4330
Provider Enumeration Date:
07/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MOHAMMADZADEH
Authorized Official First Name:
GHOLAM
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PARTNER PHYSICIAN
Authorized Official Telephone Number:
805-379-9456

Provider Taxonomy Codes

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

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

  • Identifier: CK7028 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: GR0083753 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZ23109Z . This is a "BLUE SHIELD" identifier . This identifiers is of the category "OTHER".




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