Healthcare Provider Details

I. General information

NPI: 1780715847
Provider Name (Legal Business Name): VISHVA DEV MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 09/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 W JANSS RD SUITE 360
THOUSAND OAKS CA
91360-1848
US

IV. Provider business mailing address

227 W JANSS RD SUITE 360
THOUSAND OAKS CA
91360-1848
US

V. Phone/Fax

Practice location:
  • Phone: 805-778-1111
  • Fax: 805-778-1101
Mailing address:
  • Phone: 805-778-1111
  • Fax: 805-778-1101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA53825
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberA53825
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License NumberA53825
License Number StateCA

VIII. Authorized Official

Name: DR. VISHVA DEV
Title or Position: OWNER
Credential: M.D.
Phone: 805-778-1111