Provider Demographics
NPI:1972957363
Name:NEUROVASCULAR INSTITUTE OF THOUSAND OAKS INC
Entity type:Organization
Organization Name:NEUROVASCULAR INSTITUTE OF THOUSAND OAKS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MUHAMMAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:TAQI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-423-3942
Mailing Address - Street 1:107 N REINO RD # 409
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-3710
Mailing Address - Country:US
Mailing Address - Phone:805-795-7656
Mailing Address - Fax:805-618-1501
Practice Address - Street 1:2100 LYNN RD
Practice Address - Street 2:SUITE 120
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-8033
Practice Address - Country:US
Practice Address - Phone:805-795-7656
Practice Address - Fax:805-618-1501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-21
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiologyGroup - Single Specialty