=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023159860
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THOUSAND OAKS SURGERY CENTER, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/12/2007
-----------------------------------------------------
Last Update Date | 08/23/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1120 NEWBURY RD STE 100
-----------------------------------------------------
City | THOUSAND OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91320-3663
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-557-1740
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1120 NEWBURY RD STE 100
-----------------------------------------------------
City | THOUSAND OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91320-3663
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-230-3100
-----------------------------------------------------
Fax | 805-230-1107
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | DR. ALEXANDER P HERSEL
-----------------------------------------------------
Credential | M.D
-----------------------------------------------------
Telephone | 805-557-1740
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------