Basic Information
| Provider Information | |||||||||
| NPI: | 1134762776 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SEA OUTPATIENT OBSERVATION UNIT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8 OAK PARK DR | ||||||||
| Address2: | |||||||||
| City: | BEDFORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017301414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7812801699 | ||||||||
| FaxNumber: | 7812766411 | ||||||||
| Practice Location | |||||||||
| Address1: | 3291 LOMA VISTA RD | ||||||||
| Address2: | |||||||||
| City: | VENTURA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930033099 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056526000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2019 | ||||||||
| LastUpdateDate: | 10/28/2019 | ||||||||
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| AuthorizedOfficialLastName: | ROBINSON | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | MD/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8057012437 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.