Healthcare Provider Details

I. General information

NPI: 1710813712
Provider Name (Legal Business Name): FRONTLINE HEALTHCARE 3, PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 W HILLCREST DR # 111
THOUSAND OAKS CA
91360-7883
US

IV. Provider business mailing address

225 W HILLCREST DR # 111
THOUSAND OAKS CA
91360-7883
US

V. Phone/Fax

Practice location:
  • Phone: 626-321-5755
  • Fax:
Mailing address:
  • Phone: 626-321-5755
  • Fax:

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: FUNGWAH CHRIS RUIZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 626-321-5755