Provider Demographics
NPI:1306375837
Name:CENTRAL COAST CARDIOVASCULAR ASC LLC
Entity Type:Organization
Organization Name:CENTRAL COAST CARDIOVASCULAR ASC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-258-5420
Mailing Address - Street 1:100 N BRENT ST STE 201
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-2835
Mailing Address - Country:US
Mailing Address - Phone:805-258-5420
Mailing Address - Fax:805-628-9446
Practice Address - Street 1:2000 OUTLET CENTER DR STE 225
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-0605
Practice Address - Country:US
Practice Address - Phone:805-258-5420
Practice Address - Fax:805-628-9446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-08
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical