Healthcare Provider Details

I. General information

NPI: 1821064239
Provider Name (Legal Business Name): NEWBURY PARK URGENT CARE CENTER LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 NEWBURY RD SUITE B
NEWBURY PARK CA
91320-3387
US

IV. Provider business mailing address

2080 NEWBURY RD SUITE B
NEWBURY PARK CA
91320-3387
US

V. Phone/Fax

Practice location:
  • Phone: 805-499-0308
  • Fax: 805-499-5648
Mailing address:
  • Phone: 805-499-0308
  • Fax: 805-499-5648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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