California Cerebrovascular Institute Inc

Primary specialty

Surgical Critical Care PhysicianTaxonomy code 2086S0102X

License

A112672 Issued in CA

Legal business name

CALIFORNIA CEREBROVASCULAR INSTITUTE INC

Practice address

2100 Lynn Rd
Suite 120
Thousand Oaks, CA 91360-1935

Phone

(805) 795-7656

Fax

(805) 494-8621

NPI assigned

Mar 30, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Martin M Mortazavi, M.D.

Title

Partner

Phone

(805) 795-7656

Specialties & licenses 2

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1490832000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1490832000000",
    "number": "1912439894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3435 E THOUSAND OAKS BLVD",
            "address_2": "SUITE 7735",
            "city": "WESTLAKE VILLAGE",
            "state": "CA",
            "postal_code": "913597901",
            "telephone_number": "805-795-7656",
            "fax_number": "805-494-8621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 LYNN RD",
            "address_2": "SUITE 120",
            "city": "THOUSAND OAKS",
            "state": "CA",
            "postal_code": "913601935",
            "telephone_number": "805-795-7656",
            "fax_number": "805-494-8621"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CALIFORNIA CEREBROVASCULAR INSTITUTE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-30",
        "last_updated": "2017-03-30",
        "status": "A",
        "authorized_official_last_name": "MORTAZAVI",
        "authorized_official_first_name": "MARTIN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "805-795-7656",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2086S0102X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Surgical Critical Care",
            "state": "CA",
            "license": "A112672",
            "primary": true
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "CA",
            "license": "A118331",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.