Provider Demographics
NPI:1588084859
Name:CONEJO VALLEY ELECTROPHYSIOLOGY INC.
Entity type:Organization
Organization Name:CONEJO VALLEY ELECTROPHYSIOLOGY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:MOURA
Authorized Official - Last Name:ALVES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-768-4198
Mailing Address - Street 1:501 S REINO RD STE I
Mailing Address - Street 2:SUITE 391
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-4270
Mailing Address - Country:US
Mailing Address - Phone:805-768-4198
Mailing Address - Fax:877-794-1288
Practice Address - Street 1:2220 LYNN RD
Practice Address - Street 2:SUITE 203
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-1904
Practice Address - Country:US
Practice Address - Phone:805-768-4198
Practice Address - Fax:877-794-1288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-24
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC54056207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI143936Medicare PIN