1164460648 NPI number — APOLLO HEALTH SYSTEMS

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 1164460648 NPI number — APOLLO HEALTH SYSTEMS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
APOLLO HEALTH SYSTEMS
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:
1164460648
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
920 HAMPSHIRE RD
Provider Second Line Business Mailing Address:
SUITE A28
Provider Business Mailing Address City Name:
WESTLAKE VILLAGE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91361-2816
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-777-0022
Provider Business Mailing Address Fax Number:
805-235-2050

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
920 HAMPSHIRE RD
Provider Second Line Business Practice Location Address:
SUITE A28
Provider Business Practice Location Address City Name:
WESTLAKE VILLAGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91361-2816
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-777-0022
Provider Business Practice Location Address Fax Number:
805-235-2050
Provider Enumeration Date:
06/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LARSON
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
A
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
805-777-0022

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  100-746736 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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