Healthcare Provider Details

I. General information

NPI: 1134274418
Provider Name (Legal Business Name): PRIMARY CARE SPORTS MEDICINE A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 02/19/2026
Certification Date: 02/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29229 CANWOOD ST STE 112
AGOURA HILLS CA
91301-1561
US

IV. Provider business mailing address

29229 CANWOOD ST STE 112
AGOURA HILLS CA
91301-1561
US

V. Phone/Fax

Practice location:
  • Phone: 818-501-7276
  • Fax: 818-501-7288
Mailing address:
  • Phone: 818-501-7276
  • Fax: 818-501-7288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberA62510
License Number StateCA

VIII. Authorized Official

Name: BYRON PATTERSON
Title or Position: OWNER
Credential: MD
Phone: 818-501-7276