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General NPI Number Information
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NPI Number | 1700205283
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Entity Type | Organization
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Legal Business Name | AGOURA HILLS HEALTH CARE
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Dates
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Enumeration Date | 04/10/2014
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Last Update Date | 04/18/2014
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Provider Practice Location Address
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Address Line | 29525 CANWOOD ST STE 306
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City | AGOURA HILLS
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State | CA
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Zip | 91301-4232
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Country | US
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Telephone | 818-640-5448
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Fax |
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Provider Business Mailing Address
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Address Line | 25643 MONTE NIDO DR
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City | CALABASAS
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State | CA
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Zip | 91302-2226
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Country | US
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Telephone | 818-640-5448
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | CRAIG STEVEN DOCKENDORF
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Credential |
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Telephone | 818-640-5448
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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