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General NPI Number Information
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NPI Number | 1265121446
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Entity Type | Organization
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Legal Business Name | CONEJO VALLEY PRIMARY HEALTHCARE
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Dates
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Enumeration Date | 05/03/2023
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Last Update Date | 05/23/2023
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Provider Practice Location Address
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Address Line | 1429 E THOUSAND OAKS BLVD # 108
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City | THOUSAND OAKS
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State | CA
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Zip | 91362-2801
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Country | US
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Telephone | 805-719-1700
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Fax | 805-719-1711
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Provider Business Mailing Address
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Address Line | 1429 E THOUSAND OAKS BLVD # 108
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City | THOUSAND OAKS
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State | CA
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Zip | 91362-2801
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Country | US
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Telephone | 805-719-1700
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Fax | 805-719-1711
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Authorized Official
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Title or Position | CEO
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Name | LYNN COATES-LEISEN
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Credential | FNP-C
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Telephone | 818-642-7162
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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