1700169521 NPI number — PRIORITY FAMILY HEALTH A MEDICAL CORPORATION

Table of content: (NPI 1700169521)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700169521 NPI number — PRIORITY FAMILY HEALTH A MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRIORITY FAMILY HEALTH A MEDICAL CORPORATION
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:
1700169521
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/30/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1220 LA VENTA DR
Provider Second Line Business Mailing Address:
205B
Provider Business Mailing Address City Name:
WESTLAKE VILLAGE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91361-3703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-874-3358
Provider Business Mailing Address Fax Number:
818-874-3359

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
638 LINDERO CANYON RD
Provider Second Line Business Practice Location Address:
244
Provider Business Practice Location Address City Name:
OAK PARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91377-5457
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-874-3358
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/28/2011

Additional Information

Authorized Official

Authorized Official Last Name:
KUMAR
Authorized Official First Name:
PRATIBHA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
818-874-3358

Provider Taxonomy Codes

  • Taxonomy code: 261QH0100X , with the licence number:  A40351 ; 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