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General NPI Number Information
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NPI Number | 1235921933
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Entity Type | Organization
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Legal Business Name | AGE SMART MEDICAL CORPORATION
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Dates
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Enumeration Date | 05/19/2025
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Last Update Date | 05/19/2025
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Provider Practice Location Address
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Address Line | 3435 E THOUSAND OAKS BLVD
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City | THOUSAND OAKS
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State | CA
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Zip | 91359-7901
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Country | US
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Telephone | 818-439-2160
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Fax |
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Provider Business Mailing Address
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Address Line | 3435 E THOUSAND OAKS BLVD
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City | THOUSAND OAKS
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State | CA
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Zip | 91359-7901
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | HARENDRA IPALAWATTE
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Credential | MD
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Telephone | 818-439-2160
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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