Healthcare Provider Details

I. General information

NPI: 1295305092
Provider Name (Legal Business Name): MEDICAL CORPORATION OF SOUTHERN CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2021
Last Update Date: 06/25/2021
Certification Date: 06/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3687 LAS POSAS RD STE 187H
CAMARILLO CA
93010-1431
US

IV. Provider business mailing address

3687 LAS POSAS RD STE 187H
CAMARILLO CA
93010-1431
US

V. Phone/Fax

Practice location:
  • Phone: 805-445-4189
  • Fax: 818-597-8763
Mailing address:
  • Phone: 805-445-4189
  • Fax: 818-597-8763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SUDHA REGHUNATHAN
Title or Position: CEO
Credential: MD
Phone: 818-634-7529