Provider Demographics
NPI:1578847158
Name:COMPREHENSIVE CARE OF SIMI A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:COMPREHENSIVE CARE OF SIMI A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:COMPREHENSIVE CARE OF SIMI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BROOKS
Authorized Official - Middle Name:C
Authorized Official - Last Name:MICHAELS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-578-9751
Mailing Address - Street 1:2045 ROYAL AVE STE 234
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-4600
Mailing Address - Country:US
Mailing Address - Phone:805-578-9751
Mailing Address - Fax:
Practice Address - Street 1:2045 ROYAL AVE STE 234
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-4600
Practice Address - Country:US
Practice Address - Phone:805-578-9751
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-30
Last Update Date:2016-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG60910261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care