Healthcare Provider Details

I. General information

NPI: 1144608597
Provider Name (Legal Business Name): MY HEALTH MEDICAL ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2015
Last Update Date: 06/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 S MOORPARK RD
THOUSAND OAKS CA
91361-1008
US

IV. Provider business mailing address

1710 N MOORPARK RD SUITE NUMBER 220
THOUSAND OAKS CA
91360-5133
US

V. Phone/Fax

Practice location:
  • Phone: 650-278-0804
  • Fax: 650-618-1461
Mailing address:
  • Phone: 650-278-0804
  • Fax: 650-618-1461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA79039
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License NumberA79039
License Number StateCA

VIII. Authorized Official

Name: DR. MICHAEL EDWARD EIFFERT
Title or Position: PRESIDENT
Credential: MD
Phone: 650-278-0804