Healthcare Provider Details

I. General information

NPI: 1730108366
Provider Name (Legal Business Name): AGOURA-WEST VALLEY PEDIATRIC MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7230 MEDICAL CENTER DR STE 402
WEST HILLS CA
91307-4015
US

IV. Provider business mailing address

7230 MEDICAL CENTER DR STE 402
WEST HILLS CA
91307-4015
US

V. Phone/Fax

Practice location:
  • Phone: 818-340-3822
  • Fax: 818-340-8039
Mailing address:
  • Phone: 818-340-3822
  • Fax: 818-340-8039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTOPHER JAMES TOLCHER
Title or Position: VICE PRESIDENT AND PRIVACY OFFICIAL
Credential: M.D.
Phone: 818-340-3822