Healthcare Provider Details

I. General information

NPI: 1306375837
Provider Name (Legal Business Name): CENTRAL COAST CARDIOVASCULAR ASC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2017
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 OUTLET CENTER DR STE 225
OXNARD CA
93036-0605
US

IV. Provider business mailing address

100 N BRENT ST STE 201
VENTURA CA
93003-2835
US

V. Phone/Fax

Practice location:
  • Phone: 805-258-5420
  • Fax: 805-628-9446
Mailing address:
  • Phone: 805-620-3499
  • Fax: 805-643-3331

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: MS. TAREN CESSNA
Title or Position: ADMINISTRATOR
Credential:
Phone: 805-620-3499