Healthcare Provider Details

I. General information

NPI: 1477834950
Provider Name (Legal Business Name): WEST COAST SPECIALTY SURGERY CENTER OF CALIFORNIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2011
Last Update Date: 07/14/2023
Certification Date: 07/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 SOLAR DRIVE SUITE 160
OXNARD CA
93030-0149
US

IV. Provider business mailing address

2831 N VENTURA RD
OXNARD CA
93036-2213
US

V. Phone/Fax

Practice location:
  • Phone: 805-983-1999
  • Fax: 805-983-1999
Mailing address:
  • Phone: 805-983-1999
  • Fax:

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: YULY GORODISKY
Title or Position: MEMBER
Credential:
Phone: 805-983-1999