Healthcare Provider Details

I. General information

NPI: 1548238256
Provider Name (Legal Business Name): NEWBURY PARK URGENT CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 NEWBURY RD
NEWBURY PARK CA
91320-3387
US

IV. Provider business mailing address

177 RIMROCK RD
THOUSAND OAKS CA
91361-5223
US

V. Phone/Fax

Practice location:
  • Phone: 805-499-0308
  • Fax:
Mailing address:
  • Phone: 805-557-2709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberPA13286
License Number StateCA

VIII. Authorized Official

Name: MRS. LYNETTE M HENRIOD
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 805-499-0308