Healthcare Provider Details

I. General information

NPI: 1831428861
Provider Name (Legal Business Name): OAK TREE SURGICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2009
Last Update Date: 05/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2230 LYNN RD SUITE 320
THOUSAND OAKS CA
91360-1901
US

IV. Provider business mailing address

2230 LYNN RD. SUITE 320
THOUSAND OAKS CA
91360
US

V. Phone/Fax

Practice location:
  • Phone: 805-371-8400
  • Fax: 805-371-8404
Mailing address:
  • Phone: 805-371-8400
  • Fax: 805-371-8404

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. SHAHRAM DANESHGAR
Title or Position: OWNER
Credential: M.D.
Phone: 805-371-8404