Healthcare Provider Details

I. General information

NPI: 1124364286
Provider Name (Legal Business Name): SPECIALITY HOSPITALIST INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2012
Last Update Date: 06/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 W JANSS RD
THOUSAND OAKS CA
91360-1847
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 805-497-3585
  • Fax: 805-497-1313
Mailing address:
  • Phone: 805-497-3585
  • Fax: 805-497-1313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: SANJIV GOEL
Title or Position: OWNER
Credential: M.D.
Phone: 805-497-3585