Provider Demographics
NPI:1518930270
Name:CABRILLO CARDIOLOGY MEDICAL GROUP INC.
Entity Type:Organization
Organization Name:CABRILLO CARDIOLOGY MEDICAL GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSCHEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-351-8212
Mailing Address - Street 1:2241 WANKEL WAY
Mailing Address - Street 2:STE C
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030
Mailing Address - Country:US
Mailing Address - Phone:805-351-8212
Mailing Address - Fax:805-351-8217
Practice Address - Street 1:400 CAMMARILLO RANCH RD
Practice Address - Street 2:STE 205
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010
Practice Address - Country:US
Practice Address - Phone:805-351-8212
Practice Address - Fax:805-351-8217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-10
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W298Medicare PIN