Healthcare Provider Details

I. General information

NPI: 1528998549
Provider Name (Legal Business Name): CORINE MUSGROVE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29026 LARO DR
AGOURA HILLS CA
91301-1637
US

IV. Provider business mailing address

32700 BIGSTONE PL
WESTLAKE VILLAGE CA
91361-5532
US

V. Phone/Fax

Practice location:
  • Phone: 818-625-0554
  • Fax:
Mailing address:
  • Phone: 818-625-0554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number260007138
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: