Healthcare Provider Details

I. General information

NPI: 1003216276
Provider Name (Legal Business Name): ROLLING OAKS SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2014
Last Update Date: 11/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 ROLLING OAKS DR SUITE 115
THOUSAND OAKS CA
91361-1029
US

IV. Provider business mailing address

425 HAALAND DR SUITE 200
THOUSAND OAKS CA
91361-5229
US

V. Phone/Fax

Practice location:
  • Phone: 805-373-7073
  • Fax: 805-373-1116
Mailing address:
  • Phone: 805-373-7073
  • Fax: 805-373-1116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberA79029
License Number StateCA

VIII. Authorized Official

Name: DR. KOUROS AZAR
Title or Position: MANAGER
Credential: M.D.
Phone: 805-373-7073