Healthcare Provider Details

I. General information

NPI: 1336294859
Provider Name (Legal Business Name): LOS ROBLES SURGICENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 04/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2190 LYNN RD SUITE 100
THOUSAND OAKS CA
91360-1980
US

IV. Provider business mailing address

2190 LYNN RD SUITE 100
THOUSAND OAKS CA
91360-1980
US

V. Phone/Fax

Practice location:
  • Phone: 805-497-3737
  • Fax: 805-373-8878
Mailing address:
  • Phone: 805-497-3737
  • Fax: 805-373-8878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number05000028
License Number StateCA

VIII. Authorized Official

Name: WILLIAM GREGORY SWINNEY
Title or Position: VP
Credential:
Phone: 972-789-2877