Healthcare Provider Details

I. General information

NPI: 1598696668
Provider Name (Legal Business Name): LOS ROBLES REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

865 PATRIOT DR # 100
MOORPARK CA
93021-3407
US

IV. Provider business mailing address

865 PATRIOT DR # 100
MOORPARK CA
93021-3407
US

V. Phone/Fax

Practice location:
  • Phone: 805-523-8062
  • Fax:
Mailing address:
  • Phone: 805-523-8062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TIM MYERS
Title or Position: CFO
Credential:
Phone: 805-370-4336