Provider Demographics
NPI:1588872907
Name:CALIFORNIA CENTER FOR CARDIOTHORACIC SURGERY, A MEDICAL GROUP
Entity type:Organization
Organization Name:CALIFORNIA CENTER FOR CARDIOTHORACIC SURGERY, A MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER PHYSICIAN
Authorized Official - Prefix:DR
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:91360-1980
Mailing Address - Country:US
Mailing Address - Phone:805-495-8050
Mailing Address - Fax:805-496-2160
Practice Address - Street 1:16255 VENTURA BLVD
Practice Address - Street 2:SUITE 910
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2302
Practice Address - Country:US
Practice Address - Phone:818-990-4600
Practice Address - Fax:818-990-7841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W15174AMedicare ID - Type Unspecified