Healthcare Provider Details

I. General information

NPI: 1447745054
Provider Name (Legal Business Name): AGOURA BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2018
Last Update Date: 06/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28632 ROADSIDE DR STE 170
AGOURA HILLS CA
91301-6064
US

IV. Provider business mailing address

28632 ROADSIDE DR STE 170
AGOURA HILLS CA
91301-6064
US

V. Phone/Fax

Practice location:
  • Phone: 805-383-2702
  • Fax: 818-698-6442
Mailing address:
  • Phone: 805-383-2702
  • Fax: 818-698-6442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOANN ZUNIGA
Title or Position: ADMINISTRATIVE DIRECTOR
Credential:
Phone: 805-383-2702