Healthcare Provider Details

I. General information

NPI: 1184325144
Provider Name (Legal Business Name): 625 NORTH A STREET OXNARD SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2023
Last Update Date: 03/15/2023
Certification Date: 03/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 N A ST STE 300
OXNARD CA
93030-4907
US

IV. Provider business mailing address

625 N A ST STE 300
OXNARD CA
93030-4907
US

V. Phone/Fax

Practice location:
  • Phone: 805-351-0745
  • Fax: 805-288-6744
Mailing address:
  • Phone: 805-351-0745
  • Fax: 805-288-6744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MATTHEW LEE BLOOM
Title or Position: MEDICAL DIRECTOR
Credential: DO
Phone: 805-351-0745