Healthcare Provider Details

I. General information

NPI: 1205911286
Provider Name (Legal Business Name): COMMUNITY PEDIATRIC MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 LA VENTA DRIVE #103
WESTLAKE VILLAGE CA
91361
US

IV. Provider business mailing address

1250 LA VENTA DRIVE #103
WESTLAKE VILLAGE CA
91361
US

V. Phone/Fax

Practice location:
  • Phone: 805-495-0841
  • Fax: 805-497-6912
Mailing address:
  • Phone: 805-495-0841
  • Fax: 805-497-6912

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. DAVID SCHERR
Title or Position: VICE PRESIDENT
Credential: MD
Phone: 805-495-0841