Provider Demographics
NPI:1295332633
Name:COMPASSIONATE CRITICAL CARE GROUP, INC.
Entity type:Organization
Organization Name:COMPASSIONATE CRITICAL CARE GROUP, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-383-9811
Mailing Address - Street 1:22543 VENTURA BLVD UNIT 220-401
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-1412
Mailing Address - Country:US
Mailing Address - Phone:805-383-9811
Mailing Address - Fax:805-978-5727
Practice Address - Street 1:22543 VENTURA BLVD STE 220
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-1403
Practice Address - Country:US
Practice Address - Phone:805-383-9811
Practice Address - Fax:805-987-5727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-08
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1619105426OtherOTHER