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General NPI Number Information
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NPI Number | 1003216276
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Entity Type | Organization
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Legal Business Name | ROLLING OAKS SURGERY CENTER LLC
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Dates
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Enumeration Date | 08/25/2014
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Last Update Date | 11/20/2014
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Provider Practice Location Address
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Address Line | 415 ROLLING OAKS DR SUITE 115
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City | THOUSAND OAKS
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State | CA
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Zip | 91361-1029
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Country | US
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Telephone | 805-373-7073
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Fax | 805-373-1116
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Provider Business Mailing Address
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Address Line | 425 HAALAND DR SUITE 200
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City | THOUSAND OAKS
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State | CA
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Zip | 91361-5229
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Country | US
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Telephone | 805-373-7073
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Fax | 805-373-1116
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Authorized Official
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Title or Position | MANAGER
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Name | DR. KOUROS AZAR
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Credential | M.D.
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Telephone | 805-373-7073
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | A79029
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License Number State | CA
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