Healthcare Provider Details

I. General information

NPI: 1104732361
Provider Name (Legal Business Name): PACIFIC INTERVENTIONAL CARDIOLOGY A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 LYNN RD STE 203
THOUSAND OAKS CA
91360-8009
US

IV. Provider business mailing address

3835 E THOUSAND OAKS BLVD STE 425
WESTLAKE VILLAGE CA
91362-3637
US

V. Phone/Fax

Practice location:
  • Phone: 805-494-9494
  • Fax:
Mailing address:
  • Phone: 425-306-2032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. ANDRE B AKHONDI
Title or Position: OWNER
Credential: MD
Phone: 425-306-2032