Healthcare Provider Details

I. General information

NPI: 1134762776
Provider Name (Legal Business Name): SEA OUTPATIENT OBSERVATION UNIT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2019
Last Update Date: 10/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3291 LOMA VISTA RD
VENTURA CA
93003-3099
US

IV. Provider business mailing address

8 OAK PARK DR
BEDFORD MA
01730-1414
US

V. Phone/Fax

Practice location:
  • Phone: 805-652-6000
  • Fax:
Mailing address:
  • Phone: 781-280-1699
  • Fax: 781-276-6411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY L ROBINSON
Title or Position: MD/OWNER
Credential: MD
Phone: 805-701-2437