Healthcare Provider Details

I. General information

NPI: 1023159860
Provider Name (Legal Business Name): THOUSAND OAKS SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 08/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 NEWBURY RD STE 100
THOUSAND OAKS CA
91320-3663
US

IV. Provider business mailing address

1120 NEWBURY RD STE 100
THOUSAND OAKS CA
91320-3663
US

V. Phone/Fax

Practice location:
  • Phone: 805-557-1740
  • Fax:
Mailing address:
  • Phone: 805-230-3100
  • Fax: 805-230-1107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. ALEXANDER P HERSEL
Title or Position: DIRECTOR
Credential: M.D
Phone: 805-557-1740