Provider Demographics
NPI:1356493126
Name:THOUSAND OAKS SURGICAL INSTITUTE, A.M.C
Entity Type:Organization
Organization Name:THOUSAND OAKS SURGICAL INSTITUTE, A.M.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:MAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:VENTURA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-975-1881
Mailing Address - Street 1:PO BOX 108
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90213-0108
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:375 ROLLING OAKS DR STE 110
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361-1034
Practice Address - Country:US
Practice Address - Phone:805-777-8956
Practice Address - Fax:866-586-9678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC2318624261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS051599Medicare ID - Type UnspecifiedMEDICARE ID NUMBER