MEDICARE: 625 NORTH A STREET OXNARD SURGERY CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1184325144
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	625 NORTH A STREET OXNARD SURGERY CENTER, LLC

Provider Business Mailing Address
First Line	:	625 N A ST STE 300
Second Line	:
City	:	OXNARD
State	:	CA
Zip	:	93030-4907
Country	:	US
Telephone Number	:	805-351-0745
Fax Number	:	805-288-6744

Provider Business Practice Location Address
First Line	:	625 N A ST STE 300
Second Line	:
City	:	OXNARD
State	:	CA
Zip	:	93030-4907
Country	:	US
Telephone Number	:	805-351-0745
Fax Number	:	805-288-6744

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. MATTHEW LEE BLOOM
Credential	:	DO
Telephone Number	:	805-351-0745

Provider Enumeration Date	:	03/15/2023
Last Update Date	:	03/15/2023

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