Individual
ESAM OBED
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2241 WANKEL WAY, STE C, OXNARD, CA 93030-0190
(805) 983-0922
(805) 983-1997
Mailing address
2241 WANKEL WAY, STE C, OXNARD, CA 93030-0190
(805) 983-0922
(805) 983-1997
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
A79496
CA
207RI0011X
Interventional Cardiology Physician
A79496
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A79476
BLUESHIELD
CA
Enumeration date
03/24/2006
Last updated
12/05/2007
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