Healthcare Provider Details

I. General information

NPI: 1295800308
Provider Name (Legal Business Name): CALIFORNIA CARDIOVASCULAR AND THORACIC SURGEONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 01/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

168 N BRENT ST SUITE 508
VENTURA CA
93003-2817
US

IV. Provider business mailing address

168 N BRENT ST SUITE 508
VENTURA CA
93003-2817
US

V. Phone/Fax

Practice location:
  • Phone: 805-643-2375
  • Fax: 805-643-3511
Mailing address:
  • Phone: 805-643-2375
  • Fax: 805-643-3511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LAMAR J. BUSHNELL
Title or Position: PARTNER
Credential: M.D.
Phone: 805-643-2375