Healthcare Provider Details

I. General information

NPI: 1992752166
Provider Name (Legal Business Name): ISHU V RAO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 11/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

168 N BRENT ST SUITE 503
VENTURA CA
93003-2817
US

IV. Provider business mailing address

168 N BRENT ST SUITE 503
VENTURA CA
93003-2817
US

V. Phone/Fax

Practice location:
  • Phone: 805-653-0101
  • Fax: 805-643-6285
Mailing address:
  • Phone: 805-653-0101
  • Fax: 805-643-6285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberK6258
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberA68864
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: