Healthcare Provider Details

I. General information

NPI: 1457917320
Provider Name (Legal Business Name): INTEGRATED SURGICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2019
Last Update Date: 05/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 SAINT CHARLES DR STE 101
THOUSAND OAKS CA
91360-3971
US

IV. Provider business mailing address

550 SAINT CHARLES DR STE 101
THOUSAND OAKS CA
91360-3971
US

V. Phone/Fax

Practice location:
  • Phone: 805-719-6611
  • Fax: 805-719-6622
Mailing address:
  • Phone: 805-719-6611
  • Fax: 805-719-6622

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: MS. NICOLE BROWN
Title or Position: ADMINISTRATION
Credential: COMPLIANCE
Phone: 805-719-6611