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General NPI Number Information
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NPI Number | 1841368818
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Entity Type | Organization
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Legal Business Name | TOPANGA MEDICAL CLINIC
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 395 S TOPANGA CANYON BLVD SUITE 104
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City | TOPANGA
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State | CA
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Zip | 90290-3143
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Country | US
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Telephone | 310-455-2019
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Fax | 310-455-2010
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Provider Business Mailing Address
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Address Line | 395 S TOPANGA CANYON BLVD SUITE 104
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City | TOPANGA
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State | CA
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Zip | 90290-3143
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Country | US
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Telephone | 310-455-2019
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Fax | 310-455-2010
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DOUGLAS PENDLETON ROY
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Credential | M.D.
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Telephone | 310-455-2019
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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 | G-037170
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License Number State | CA
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