Healthcare Provider Details

I. General information

NPI: 1003231119
Provider Name (Legal Business Name): CIANO AMBULATORY SURGICAL FACILITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2014
Last Update Date: 02/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2190 LYNN RD STE 310
THOUSAND OAKS CA
91360-8025
US

IV. Provider business mailing address

2190 LYNN RD STE 310
THOUSAND OAKS CA
91360-8025
US

V. Phone/Fax

Practice location:
  • Phone: 805-497-8411
  • Fax: 805-496-5632
Mailing address:
  • Phone: 805-497-8411
  • Fax: 805-496-5632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number1401
License Number StateCA

VIII. Authorized Official

Name: JAMES WATSON
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 805-497-8411