Provider Demographics
NPI:1649471061
Name:SOUTHERN CALIFORNIA ADVANCED LAPARO ENDOSCOPIC SURGERY
Entity type:Organization
Organization Name:SOUTHERN CALIFORNIA ADVANCED LAPARO ENDOSCOPIC SURGERY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARDILINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-306-1849
Mailing Address - Street 1:415 ROLLING OAKS DR
Mailing Address - Street 2:SUITE 240
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91361-1029
Mailing Address - Country:US
Mailing Address - Phone:805-230-0030
Mailing Address - Fax:805-306-1849
Practice Address - Street 1:415 ROLLING OAKS DR
Practice Address - Street 2:SUITE 240
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361-1029
Practice Address - Country:US
Practice Address - Phone:805-230-0030
Practice Address - Fax:805-306-1849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty