Organization
CALIFORNIA CEREBROVASCULAR INSTITUTE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARTIN M MORTAZAVI M.D. (PARTNER)
(805) 795-7656
Entity
Organization
Contact information
Practice address
2100 LYNN RD, SUITE 120, THOUSAND OAKS, CA 91360-1935
(805) 795-7656
(805) 494-8621
Mailing address
3435 E THOUSAND OAKS BLVD, SUITE 7735, WESTLAKE VILLAGE, CA 91359-7901
(805) 795-7656
(805) 494-8621
Taxonomy
Speciality
Code
Description
License number
State
2086S0102X
Surgical Critical Care Physician
Primary
A112672
CA
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
A118331
CA
Other
Enumeration date
03/30/2017
Last updated
03/30/2017
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