MEDICARE: NEWBURY PARK URGENT CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center	PA13286	CA

General Provider Information

NPI Number	:	1548238256
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEWBURY PARK URGENT CARE

Provider Business Mailing Address
First Line	:	177 RIMROCK RD
Second Line	:
City	:	THOUSAND OAKS
State	:	CA
Zip	:	91361-5223
Country	:	US
Telephone Number	:	805-557-2709
Fax Number	:

Provider Business Practice Location Address
First Line	:	2080 NEWBURY RD
Second Line	:
City	:	NEWBURY PARK
State	:	CA
Zip	:	91320-3387
Country	:	US
Telephone Number	:	805-499-0308
Fax Number	:

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	MRS. LYNETTE M HENRIOD
Credential	:
Telephone Number	:	805-499-0308

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	08/22/2020

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