Provider Demographics
NPI:1407557960
Name:VINCENT POGO HEALTH OF NV PC
Entity Type:Organization
Organization Name:VINCENT POGO HEALTH OF NV PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MALONEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-975-0006
Mailing Address - Street 1:2287 MULHOLLAND HWY
Mailing Address - Street 2:#526
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:90290
Mailing Address - Country:US
Mailing Address - Phone:805-975-0006
Mailing Address - Fax:
Practice Address - Street 1:26342 FAIRSIDE RD
Practice Address - Street 2:
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-2927
Practice Address - Country:US
Practice Address - Phone:805-975-5006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-13
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty