Healthcare Provider Details

I. General information

NPI: 1912077314
Provider Name (Legal Business Name): CHANNEL ISLANDS PLASTIC & RECONSTRUCTIVE SURGERY MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 SOLAR DR #150
OXNARD CA
93030-8234
US

IV. Provider business mailing address

11999 SAN VICENTE BLVD #440
LOS ANGELES CA
90049-5131
US

V. Phone/Fax

Practice location:
  • Phone: 805-983-1999
  • Fax:
Mailing address:
  • Phone: 310-471-5852
  • Fax: 310-471-3958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberA39823
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA39823
License Number StateCA

VIII. Authorized Official

Name: DR. WILLIAM E. STARR
Title or Position: OWNER
Credential: M.D.
Phone: 805-983-1999