Provider Demographics
NPI:1548238256
Name:NEWBURY PARK URGENT CARE
Entity Type:Organization
Organization Name:NEWBURY PARK URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNETTE
Authorized Official - Middle Name:M
Authorized Official - Last Name:HENRIOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-499-0308
Mailing Address - Street 1:177 RIMROCK RD
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91361-5223
Mailing Address - Country:US
Mailing Address - Phone:805-557-2709
Mailing Address - Fax:
Practice Address - Street 1:2080 NEWBURY RD
Practice Address - Street 2:
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-3387
Practice Address - Country:US
Practice Address - Phone:805-499-0308
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA13286261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS74908Medicare UPIN