Provider Demographics
NPI:1407803323
Name:CARDIOVASCULAR & THORACIC SURGEONS OF VENTURA COUNTY, APC
Entity Type:Organization
Organization Name:CARDIOVASCULAR & THORACIC SURGEONS OF VENTURA COUNTY, APC
Other - Org Name:RICHARD J DECLUSIN, MD, PHD, APC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:DECLUSIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-988-2033
Mailing Address - Street 1:1700 N ROSE AVE
Mailing Address - Street 2:STE 420
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-7656
Mailing Address - Country:US
Mailing Address - Phone:805-988-2033
Mailing Address - Fax:805-983-6839
Practice Address - Street 1:1700 N ROSE AVE
Practice Address - Street 2:STE 420
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-7656
Practice Address - Country:US
Practice Address - Phone:805-988-2033
Practice Address - Fax:805-983-6839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0087650Medicaid
ZZZ07779ZOtherBLUE SHIELD
ZZZ07779ZOtherBLUE SHIELD
HW14069Medicare ID - Type Unspecified