Provider Demographics
NPI:1932782893
Name:ENT SPECIALISTS & SURGEONS OF SOUTHERN CALIFORNIA, A MEDICAL CORPORATI
Entity Type:Organization
Organization Name:ENT SPECIALISTS & SURGEONS OF SOUTHERN CALIFORNIA, A MEDICAL CORPORATI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SARANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:REGHUNATHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-671-7969
Mailing Address - Street 1:3687 LAS POSAS RD STE 187H
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-1431
Mailing Address - Country:US
Mailing Address - Phone:818-634-7529
Mailing Address - Fax:818-597-8763
Practice Address - Street 1:3687 LAS POSAS RD STE 187H
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-1431
Practice Address - Country:US
Practice Address - Phone:818-634-7529
Practice Address - Fax:818-597-8763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty