MEDICARE: ATC HEALTH SERVICES INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1700439817
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATC HEALTH SERVICES INC.

Provider Business Mailing Address
First Line	:	1925 ROYAL AVE STE B
Second Line	:
City	:	SIMI VALLEY
State	:	CA
Zip	:	93065-4619
Country	:	US
Telephone Number	:	805-501-5715
Fax Number	:	818-794-6036

Provider Business Practice Location Address
First Line	:	1925 ROYAL AVE STE B
Second Line	:
City	:	SIMI VALLEY
State	:	CA
Zip	:	93065-4619
Country	:	US
Telephone Number	:	805-501-5715
Fax Number	:	818-794-6036

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	ARCHANA THUKRAL
Credential	:
Telephone Number	:	805-501-5715

Provider Enumeration Date	:	07/17/2019
Last Update Date	:	07/17/2019

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