Healthcare Provider Details

I. General information

NPI: 1396023255
Provider Name (Legal Business Name): PACIFIC COAST SURGICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2011
Last Update Date: 07/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3195 OLD CONEJO RD
THOUSAND OAKS CA
91320-2151
US

IV. Provider business mailing address

3195 OLD CONEJO RD
THOUSAND OAKS CA
91320-2151
US

V. Phone/Fax

Practice location:
  • Phone: 310-914-9150
  • Fax: 310-914-9705
Mailing address:
  • Phone: 310-914-9150
  • Fax: 310-914-9705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GOLNAZ SAEDI
Title or Position: MEDICAL DOCTOR
Credential: M.D.
Phone: 310-914-9705