Healthcare Provider Details

I. General information

NPI: 1841492543
Provider Name (Legal Business Name): AFFILIATED SURGICAL ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 06/09/2022
Certification Date: 06/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 LAS POSAS RD STE C
CAMARILLO CA
93010-2910
US

IV. Provider business mailing address

2674 E MAIN ST STE E-928
VENTURA CA
93003-2820
US

V. Phone/Fax

Practice location:
  • Phone: 805-620-1000
  • Fax: 805-209-2741
Mailing address:
  • Phone: 805-620-1000
  • Fax: 805-209-2741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number21784
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: TERRY LIDVIN SIMPSON
Title or Position: PRESIDENT/CEO
Credential: MD
Phone: 805-620-1000