Healthcare Provider Details

I. General information

NPI: 1184020752
Provider Name (Legal Business Name): SIREZ MEDICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2014
Last Update Date: 11/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 HODENCAMP RD STE 103
THOUSAND OAKS CA
91360-5831
US

IV. Provider business mailing address

15550 ROCKFIELD BLVD B220
IRVINE CA
92618-2720
US

V. Phone/Fax

Practice location:
  • Phone: 805-777-7003
  • Fax: 805-777-7043
Mailing address:
  • Phone: 949-598-9999
  • Fax: 949-598-9990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberA42285
License Number StateCA

VIII. Authorized Official

Name: DR. VIKRAM JEET SINGH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 805-777-7003