# CONEJO VALLEY OUTPATIENT CENTER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1437567765
- **Authorized official:** ROBERT FAN MD (MEDICAL DIRECTOR)
- **Authorized official phone:** (310) 846-4155

## Contact information

- **Practice address:** 1127 WILSHIRE BLVD, SUITE 1000, LOS ANGELES, CA 90017-3901
- **Practice address phone:** (310) 846-4155
- **Mailing address:** PO BOX 881840, LOS ANGELES, CA 90009-3013

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 07/30/2014
- **Last updated:** 11/02/2015