Provider Demographics
NPI:1538104492
Name:WESTLAKE VILLAGE URGENT CARE OCCUPATIONAL AND FAMILY MEDICAL CLINIC
Entity Type:Organization
Organization Name:WESTLAKE VILLAGE URGENT CARE OCCUPATIONAL AND FAMILY MEDICAL CLINIC
Other - Org Name:WESTLAKE VILLAGE URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVGAN-KACKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-874-0900
Mailing Address - Street 1:4607 LAKEVIEW CANYON #404
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361
Mailing Address - Country:US
Mailing Address - Phone:805-379-9125
Mailing Address - Fax:805-379-2311
Practice Address - Street 1:2900 TOWNSGATE ROAD
Practice Address - Street 2:SUITE #103
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361
Practice Address - Country:US
Practice Address - Phone:805-379-9125
Practice Address - Fax:805-379-2311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA607070207Q00000X
CAA67070261QU0200X, 261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW15260Medicare PIN
CAWA82333AMedicare PIN
CAWA64109BMedicare PIN