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General NPI Number Information
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NPI Number | 1790138402
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Entity Type | Organization
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Legal Business Name | PROMINENCE CORPORATION
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Dates
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Enumeration Date | 07/18/2016
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Last Update Date | 07/18/2016
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Provider Practice Location Address
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Address Line | 4505 LAS VIRGENES RD SUITE 207
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City | CALABASAS
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State | CA
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Zip | 91302-1956
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Country | US
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Telephone | 818-878-6900
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Fax | 818-878-6902
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Provider Business Mailing Address
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Address Line | 4505 LAS VIRGENES RD SUITE 217
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City | CALABASAS
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State | CA
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Zip | 91302-1956
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Country | US
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Telephone | 818-878-6900
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Fax | 818-878-6902
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Authorized Official
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Title or Position | CEO
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Name | YAHYA NAVAB
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Credential |
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Telephone | 310-433-9656
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 190722BP
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License Number State | CA
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