Healthcare Provider Details

I. General information

NPI: 1821031675
Provider Name (Legal Business Name): COASTAL VASCULAR CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2841 N VENTURA RD STE 200
OXNARD CA
93036-2213
US

IV. Provider business mailing address

1901 OUTLET CENTER DRIVE SUITE 230
OXNARD CA
93036-6073
US

V. Phone/Fax

Practice location:
  • Phone: 805-983-6233
  • Fax: 805-983-2459
Mailing address:
  • Phone: 805-983-6233
  • Fax: 805-983-2459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA40288
License Number StateCA

VIII. Authorized Official

Name: GREGORY K ALBAUGH
Title or Position: PRESIDENT
Credential: D.O.
Phone: 805-983-6233