Healthcare Provider Details

I. General information

NPI: 1790708782
Provider Name (Legal Business Name): VIJAY K GARG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 12/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 MACAW LN
SIMI VALLEY CA
93065-3152
US

IV. Provider business mailing address

142 MACAW LN
SIMI VALLEY CA
93065-3152
US

V. Phone/Fax

Practice location:
  • Phone: 805-522-3811
  • Fax: 805-522-2115
Mailing address:
  • Phone: 805-522-3811
  • Fax: 805-522-2115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA35932
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: