Healthcare Provider Details

I. General information

NPI: 1295332633
Provider Name (Legal Business Name): COMPASSIONATE CRITICAL CARE GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2020
Last Update Date: 11/02/2020
Certification Date: 10/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22543 VENTURA BLVD STE 220
WOODLAND HILLS CA
91364-1403
US

IV. Provider business mailing address

22543 VENTURA BLVD UNIT 220-401
WOODLAND HILLS CA
91364-1412
US

V. Phone/Fax

Practice location:
  • Phone: 805-383-9811
  • Fax: 805-987-5727
Mailing address:
  • Phone: 805-383-9811
  • Fax: 805-978-5727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DAWN MAZZA
Title or Position: BILLER
Credential:
Phone: 805-383-9811