Healthcare Provider Details

I. General information

NPI: 1306399100
Provider Name (Legal Business Name): BITA Z. FARRELL, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2016
Last Update Date: 07/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 W JANSS RD
THOUSAND OAKS CA
91360-1847
US

IV. Provider business mailing address

1633 ERRINGER RD 1ST FLOOR
SIMI VALLEY CA
93065-3583
US

V. Phone/Fax

Practice location:
  • Phone: 805-497-2727
  • Fax:
Mailing address:
  • Phone: 805-578-8300
  • Fax: 805-578-3911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA70020
License Number StateCA

VIII. Authorized Official

Name: BITA FARRELL
Title or Position: PRESIDENT
Credential:
Phone: 310-488-5496