1871705244 NPI number — CITY STATIONS, INC.

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 1871705244 NPI number — CITY STATIONS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY STATIONS, INC.
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:
6
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:
1871705244
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1534 N MOORPARK RD
Provider Second Line Business Mailing Address:
420
Provider Business Mailing Address City Name:
THOUSAND OAKS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91360-5129
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-825-9439
Provider Business Mailing Address Fax Number:
866-317-1094

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1145 LINDERO CANYON RD
Provider Second Line Business Practice Location Address:
D10
Provider Business Practice Location Address City Name:
WESTLAKE VILLAGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91362-5475
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-706-2390
Provider Business Practice Location Address Fax Number:
818-706-6093
Provider Enumeration Date:
05/05/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NOVACEK
Authorized Official First Name:
LISA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
818-825-9439

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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