Provider Demographics
NPI:1912439894
Name:CALIFORNIA CEREBROVASCULAR INSTITUTE INC
Entity Type:Organization
Organization Name:CALIFORNIA CEREBROVASCULAR INSTITUTE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MORTAZAVI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-795-7656
Mailing Address - Street 1:3435 E THOUSAND OAKS BLVD
Mailing Address - Street 2:SUITE 7735
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91359-7901
Mailing Address - Country:US
Mailing Address - Phone:805-795-7656
Mailing Address - Fax:805-494-8621
Practice Address - Street 1:2100 LYNN RD
Practice Address - Street 2:SUITE 120
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-1935
Practice Address - Country:US
Practice Address - Phone:805-795-7656
Practice Address - Fax:805-494-8621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-30
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1126722086S0102X
CAA118331208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical CareGroup - Multi-Specialty
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty