# CALIFORNIA CEREBROVASCULAR INSTITUTE INC

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

## Provider details

- **NPI number:** 1912439894
- **Authorized official:** MARTIN M MORTAZAVI M.D. (PARTNER)
- **Authorized official phone:** (805) 795-7656

## Contact information

- **Practice address:** 2100 LYNN RD, SUITE 120, THOUSAND OAKS, CA 91360-1935
- **Practice address phone:** (805) 795-7656
- **Practice address fax:** (805) 494-8621
- **Mailing address:** 3435 E THOUSAND OAKS BLVD, SUITE 7735, WESTLAKE VILLAGE, CA 91359-7901
- **Mailing address phone:** (805) 795-7656
- **Mailing address fax:** (805) 494-8621

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0102X | Surgical Critical Care Physician | A112672 | CA | Yes |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | A118331 | CA | — |

## Other

- **Enumeration date:** 03/30/2017
- **Last updated:** 03/30/2017