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General NPI Number Information
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NPI Number | 1780894063
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Entity Type | Organization
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Legal Business Name | CONEJO ANESTHESIA
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 351 ROLLING OAKS DR STE 101
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City | THOUSAND OAKS
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State | CA
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Zip | 91361-1275
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Country | US
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Telephone | 805-497-1105
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 NEWBURY RD STE 145
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City | NEWBURY PARK
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State | CA
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Zip | 91320-6435
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Country | US
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Telephone | 805-498-3696
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Fax | 805-498-3756
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Authorized Official
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Title or Position | PARTNER
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Name | CYNTHIA JACOBSON
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Credential | CRNA
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Telephone | 805-498-3696
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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