Healthcare Provider Details

I. General information

NPI: 1912362955
Provider Name (Legal Business Name): ST CHARLES SURGICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2015
Last Update Date: 12/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 SAINT CHARLES DR SUITE 101
THOUSAND OAKS CA
91360-3951
US

IV. Provider business mailing address

550 SAINT CHARLES DR SUITE 101
THOUSAND OAKS CA
91360-3951
US

V. Phone/Fax

Practice location:
  • Phone: 805-557-7050
  • Fax: 805-557-4992
Mailing address:
  • Phone: 805-557-7050
  • Fax: 805-557-4992

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. JAMES THOMAS LIN
Title or Position: CEO/MEDICAL DIRECTOR
Credential: M.D.
Phone: 805-557-7050