Basic Information
| Provider Information | |||||||||
| NPI: | 1366610024 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THOUSAND OAKS ORTHOPEADIC GROUP INC P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 425 HAALAND DR | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | THOUSAND OAKS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022982653 | ||||||||
| FaxNumber: | 6022982686 | ||||||||
| Practice Location | |||||||||
| Address1: | 425 HAALAND DR | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | THOUSAND OAKS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022982653 | ||||||||
| FaxNumber: | 6022982686 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2008 | ||||||||
| LastUpdateDate: | 02/15/2008 | ||||||||
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| AuthorizedOfficialLastName: | HERSEL | ||||||||
| AuthorizedOfficialFirstName: | ALEXANDER | ||||||||
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| AuthorizedOfficialTitleorPosition: | PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 6022982653 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | C27645 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.