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General NPI Number Information
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NPI Number | 1922100072
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Entity Type | Organization
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Legal Business Name | CONEJO VALLEY MTU
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Dates
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Enumeration Date | 09/01/2006
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Last Update Date | 09/18/2023
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Provider Practice Location Address
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Address Line | 1135 WINDSOR DR
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-5228
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Country | US
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Telephone | 805-497-4590
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Fax | 805-374-9151
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Provider Business Mailing Address
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Address Line | 2401 LOS FELIZ DR
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City | THOUSAND OAKS
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State | CA
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Zip | 91362-3153
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Country | US
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Telephone | 805-497-4590
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Fax | 805-374-9151
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Authorized Official
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Title or Position | MANAGER
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Name | LAURELL MAURO
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Credential | PT
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Telephone | 805-981-5223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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