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General NPI Number Information
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NPI Number | 1285731307
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Entity Type | Organization
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Legal Business Name | CARDIOVASCULAR PERFUSION SYSTEMS
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1330 CORTE DE PRIMAVERA
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-7026
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Country | US
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Telephone | 805-428-1275
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Fax | 805-523-2845
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Provider Business Mailing Address
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Address Line | 1330 CORTE DE PRIMAVERA
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-7026
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Country | US
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Telephone | 805-428-1275
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Fax | 805-523-2845
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. THEODORE ARTHUR RANDOLPH
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Credential | CCP
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Telephone | 805-428-1275
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246XC2903X
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Taxonomy Name | Vascular Specialist/Technologist Cardiovascular
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License Number |
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License Number State | CA
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