Healthcare Provider Details

I. General information

NPI: 1518930270
Provider Name (Legal Business Name): CABRILLO CARDIOLOGY MEDICAL GROUP INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 11/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 CAMMARILLO RANCH RD STE 205
CAMARILLO CA
93010
US

IV. Provider business mailing address

2241 WANKEL WAY STE C
OXNARD CA
93030
US

V. Phone/Fax

Practice location:
  • Phone: 805-351-8212
  • Fax: 805-351-8217
Mailing address:
  • Phone: 805-351-8212
  • Fax: 805-351-8217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. KRISTI BOSCHEE
Title or Position: OFFICE MANAGER
Credential:
Phone: 805-351-8212