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General NPI Number Information
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NPI Number | 1588084859
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Entity Type | Organization
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Legal Business Name | CONEJO VALLEY ELECTROPHYSIOLOGY INC.
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Dates
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Enumeration Date | 04/24/2014
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Last Update Date | 04/24/2014
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Provider Practice Location Address
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Address Line | 2220 LYNN RD SUITE 203
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-1904
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Country | US
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Telephone | 805-768-4198
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Fax | 877-794-1288
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Provider Business Mailing Address
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Address Line | 501 S REINO RD STE I SUITE 391
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City | NEWBURY PARK
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State | CA
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Zip | 91320-4270
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Country | US
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Telephone | 805-768-4198
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Fax | 877-794-1288
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Authorized Official
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Title or Position | PRESIDENT
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Name | CARLOS MOURA ALVES
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Credential | MD
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Telephone | 805-768-4198
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0001X
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Taxonomy Name | Clinical Cardiac Electrophysiology Physician
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License Number | C54056
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License Number State | CA
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