Healthcare Provider Details

I. General information

NPI: 1811955883
Provider Name (Legal Business Name): THOUSAND OAKS ENDOSCOPY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 03/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 W JANSS RD SUITE 240
THOUSAND OAKS CA
91360-1848
US

IV. Provider business mailing address

227 W JANSS RD SUITE 240
THOUSAND OAKS CA
91360-1848
US

V. Phone/Fax

Practice location:
  • Phone: 805-371-0455
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: RICHARD L. SHARFF JR.
Title or Position: VP/SECRETARY
Credential:
Phone: 205-545-2572