Provider Demographics
NPI:1316976327
Name:CALIFORNIA CENTER FOR CARDIOTHORACIC SURGERY
Entity type:Organization
Organization Name:CALIFORNIA CENTER FOR CARDIOTHORACIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:GHOLAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:MOHAMMADZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-379-9456
Mailing Address - Street 1:2190 LYNN RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360
Mailing Address - Country:US
Mailing Address - Phone:805-495-8050
Mailing Address - Fax:805-496-2160
Practice Address - Street 1:2100 LYNN RD
Practice Address - Street 2:SUITE 100
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360
Practice Address - Country:US
Practice Address - Phone:805-379-9456
Practice Address - Fax:805-494-4330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CK7028OtherRAILROAD MEDICARE
CAGR0083753Medicaid
ZZZ23109ZOtherBLUE SHIELD
W15174AMedicare ID - Type Unspecified
CAGR0083753Medicaid