Provider Demographics
NPI:1285731307
Name:CARDIOVASCULAR PERFUSION SYSTEMS
Entity type:Organization
Organization Name:CARDIOVASCULAR PERFUSION SYSTEMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:RANDOLPH
Authorized Official - Suffix:
Authorized Official - Credentials:CCP
Authorized Official - Phone:805-428-1275
Mailing Address - Street 1:1330 CORTE DE PRIMAVERA
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-7026
Mailing Address - Country:US
Mailing Address - Phone:805-428-1275
Mailing Address - Fax:805-523-2845
Practice Address - Street 1:1330 CORTE DE PRIMAVERA
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-7026
Practice Address - Country:US
Practice Address - Phone:805-428-1275
Practice Address - Fax:805-523-2845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA246XC2903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246XC2903XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularVascular SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA246XC2903XOtherTECNOLGISTS, TECHNICIANS