Provider Demographics
NPI:1730498957
Name:THOUSAND OAKS HEART CENTER
Entity Type:Organization
Organization Name:THOUSAND OAKS HEART CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SANJIV
Authorized Official - Middle Name:
Authorized Official - Last Name:GOEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-497-7594
Mailing Address - Street 1:2100 LYNN RD
Mailing Address - Street 2:205
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-1935
Mailing Address - Country:US
Mailing Address - Phone:805-497-7594
Mailing Address - Fax:
Practice Address - Street 1:2100 LYNN RD
Practice Address - Street 2:205
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-1935
Practice Address - Country:US
Practice Address - Phone:805-497-7594
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center