Provider Demographics
NPI:1366610024
Name:THOUSAND OAKS ORTHOPEADIC GROUP INC P.C.
Entity type:Organization
Organization Name:THOUSAND OAKS ORTHOPEADIC GROUP INC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:HERSEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-298-2653
Mailing Address - Street 1:425 HAALAND DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91361
Mailing Address - Country:US
Mailing Address - Phone:602-298-2653
Mailing Address - Fax:602-298-2686
Practice Address - Street 1:425 HAALAND DR
Practice Address - Street 2:SUITE 101
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361
Practice Address - Country:US
Practice Address - Phone:602-298-2653
Practice Address - Fax:602-298-2686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-15
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC27645207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty