1538897590 NPI number — CALIFORNIA CONCIERGE PHYSICIANS PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538897590 NPI number — CALIFORNIA CONCIERGE PHYSICIANS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CALIFORNIA CONCIERGE PHYSICIANS PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538897590
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/09/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
681 ORANGEBURGH RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIVER VALE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07675-6404
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-287-1120
Provider Business Mailing Address Fax Number:
888-411-5515

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11333 MOORPARK STREET
Provider Second Line Business Practice Location Address:
SUITE 16
Provider Business Practice Location Address City Name:
STUDIO CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
833-999-0090
Provider Business Practice Location Address Fax Number:
800-411-5515
Provider Enumeration Date:
08/09/2022

Additional Information

Authorized Official

Authorized Official Last Name:
BARSOUMIAN
Authorized Official First Name:
RAFFI
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
516-287-1120

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com