Healthcare Provider Details

I. General information

NPI: 1023992641
Provider Name (Legal Business Name): RETINA INSTITUTE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2025
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30200 AGOURA RD STE 140
AGOURA HILLS CA
91301-5426
US

IV. Provider business mailing address

30200 AGOURA RD STE 140
AGOURA HILLS CA
91301-5426
US

V. Phone/Fax

Practice location:
  • Phone: 747-247-8400
  • Fax: 747-247-8111
Mailing address:
  • Phone: 747-247-8400
  • Fax: 747-247-8111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number
License Number State

VIII. Authorized Official

Name: MOISES ENGHELBERG
Title or Position: OWNER
Credential: DO
Phone: 954-701-3912