| Agoura Hills Health Care | |
|
29525 Canwood St Ste 306 Agoura Hills CA 91301-4232 | |
| (818) 640-5448 | |
| Not Available |
| Full Name | Agoura Hills Health Care |
|---|---|
| Speciality | Clinic/Center |
| Location | 29525 Canwood St Ste 306, Agoura Hills, California |
| Authorized Official Name and Position | Craig Steven Dockendorf (CFO) |
| Authorized Official Contact | 8186405448 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Agoura Hills Health Care 25643 Monte Nido Dr Calabasas CA 91302-2226 Ph: (818) 640-5448 | Agoura Hills Health Care 29525 Canwood St Ste 306 Agoura Hills CA 91301-4232 Ph: (818) 640-5448 |
| NPI Number | 1700205283 |
|---|---|
| Provider Enumeration Date | 04/10/2014 |
| Last Update Date | 04/18/2014 |
| Medicare PECOS PAC ID | 1254555790 |
|---|---|
| Medicare Enrollment ID | O20140624000847 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700205283 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Lucille C Thomas |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1114995768 PECOS PAC ID: 3375537889 Enrollment ID: I20050803001204 |
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