Healthcare Provider Details

I. General information

NPI: 1114216892
Provider Name (Legal Business Name): SOUTHERN CALIFORNIA ANESTHESIA & PAIN MANAGEMENT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2011
Last Update Date: 04/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 HAALAND DR SUITE#101
THOUSAND OAKS CA
91361-5229
US

IV. Provider business mailing address

425 HAALAND DR SUITE#101
THOUSAND OAKS CA
91361-5229
US

V. Phone/Fax

Practice location:
  • Phone: 805-557-1113
  • Fax:
Mailing address:
  • Phone: 805-557-1113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberA85646
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA85646
License Number StateCA

VIII. Authorized Official

Name: ANA CAMPBELL
Title or Position: ADMINISTRATOR
Credential:
Phone: 805-557-1113