Healthcare Provider Details

I. General information

NPI: 1982675039
Provider Name (Legal Business Name): ST. JOHN'S OUTPATIENT SURGERY CENTER, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 05/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 NORTH ROSE AVENUE SUITE 100
OXNARD CA
93030-3796
US

IV. Provider business mailing address

1700 NORTH ROSE AVENUE SUITE 100
OXNARD CA
93030-3796
US

V. Phone/Fax

Practice location:
  • Phone: 805-204-5000
  • Fax: 805-204-5010
Mailing address:
  • Phone: 805-204-5000
  • Fax: 805-204-5010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number06-00085474
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: KATHERINE L. REED
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 972-763-3859