Healthcare Provider Details

I. General information

NPI: 1346259686
Provider Name (Legal Business Name): JURIS PRIEDKALNS, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 03/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 W JANSS RD
THOUSAND OAKS CA
91360-1847
US

IV. Provider business mailing address

PO BOX 10076
VAN NUYS CA
91410-0076
US

V. Phone/Fax

Practice location:
  • Phone: 310-471-5852
  • Fax: 310-471-3958
Mailing address:
  • Phone: 805-578-8300
  • Fax: 805-578-8950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG24295
License Number StateCA

VIII. Authorized Official

Name: MR. JURIS PRIEDKALNS
Title or Position: OWNER
Credential: M.D.
Phone: 310-471-5852