Healthcare Provider Details

I. General information

NPI: 1154773877
Provider Name (Legal Business Name): HILLSIDE MALIBU CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2016
Last Update Date: 01/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4505 LAS VIRGENES RD SUITE 211
CALABASAS CA
91302-1956
US

IV. Provider business mailing address

4505 LAS VIRGENES RD SUITE 211
CALABASAS CA
91302-1956
US

V. Phone/Fax

Practice location:
  • Phone: 818-706-9000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number190971AP
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number190971AP
License Number StateCA

VIII. Authorized Official

Name: MR. YAHYA NAVAB
Title or Position: CEO
Credential:
Phone: 818-706-9000