Healthcare Provider Details

I. General information

NPI: 1487701215
Provider Name (Legal Business Name): PLASTIC SURGERY CENTER OF THOUSAND OAKS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 ROLLING OAKS DR SUITE 101
THOUSAND OAKS CA
91361-1275
US

IV. Provider business mailing address

351 ROLLING OAKS DR SUITE 101
THOUSAND OAKS CA
91361-1275
US

V. Phone/Fax

Practice location:
  • Phone: 805-497-1105
  • Fax: 805-497-6144
Mailing address:
  • Phone: 805-497-1105
  • Fax: 805-497-6144

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: BRIAN H SLYWKA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 805-497-1105