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General NPI Number Information
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NPI Number | 1043840465
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Entity Type | Organization
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Legal Business Name | AGOURA HILLS URGENTOCARE PC
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Dates
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Enumeration Date | 01/24/2020
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Last Update Date | 01/21/2025
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Provider Practice Location Address
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Address Line | 5825 KANAN RD
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City | AGOURA HILLS
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State | CA
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Zip | 91301-1651
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Country | US
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Telephone | 424-355-1963
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Fax |
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Provider Business Mailing Address
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Address Line | 5825 KANAN RD STE B
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City | AGOURA HILLS
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State | CA
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Zip | 91301-1691
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Country | US
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Telephone | 818-483-0775
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SVETLANA KERTANOVA
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Credential | CEO
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Telephone | 818-483-0775
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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