Provider Demographics
NPI:1457481822
Name:CONEJO VALLEY WOMEN'S RESOURCE CENTER
Entity Type:Organization
Organization Name:CONEJO VALLEY WOMEN'S RESOURCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CENTER DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:R
Authorized Official - Last Name:BORG
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:805-373-1222
Mailing Address - Street 1:80 E HILLCREST DR # 130
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-4218
Mailing Address - Country:US
Mailing Address - Phone:805-373-1222
Mailing Address - Fax:
Practice Address - Street 1:80 E HILLCREST DR # 130
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-4218
Practice Address - Country:US
Practice Address - Phone:805-373-1222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACMM71123FMedicaid