Basic Information
| Provider Information | |||||||||
| NPI: | 1366643751 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SPECIALTY SURGICAL CENTER OF THOUSAND OAKS, L.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 696 HAMPSHIRE ROAD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | WESTLAKE VILLAGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8054137920 | ||||||||
| FaxNumber: | 8054137921 | ||||||||
| Practice Location | |||||||||
| Address1: | 696 HAMPSHIRE ROAD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | WESTLAKE VILLAGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913614456 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8054137920 | ||||||||
| FaxNumber: | 8054137921 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2007 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | COHEN | ||||||||
| AuthorizedOfficialFirstName: | GLENN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8053706877 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | CA | N | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.