Healthcare Provider Details

I. General information

NPI: 1821501115
Provider Name (Legal Business Name): VIP EMERGENT CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2017
Last Update Date: 11/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2944 TAPO CANYON RD STE A
SIMI VALLEY CA
93063-0903
US

IV. Provider business mailing address

26500 AGOURA RD # 102-365
CALABASAS CA
91302-1952
US

V. Phone/Fax

Practice location:
  • Phone: 805-306-5990
  • Fax: 818-743-7564
Mailing address:
  • Phone: 805-306-5990
  • Fax: 818-743-7564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAMIE DIAZ
Title or Position: OWNER
Credential: MD
Phone: 805-306-5990