Provider Demographics
NPI:1730108366
Name:AGOURA-WEST VALLEY PEDIATRIC MEDICAL GROUP
Entity Type:Organization
Organization Name:AGOURA-WEST VALLEY PEDIATRIC MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT AND PRIVACY OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:TOLCHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-340-3822
Mailing Address - Street 1:7230 MEDICAL CENTER DR STE 402
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-4015
Mailing Address - Country:US
Mailing Address - Phone:818-340-3822
Mailing Address - Fax:818-340-8039
Practice Address - Street 1:7230 MEDICAL CENTER DR STE 402
Practice Address - Street 2:
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-4015
Practice Address - Country:US
Practice Address - Phone:818-340-3822
Practice Address - Fax:818-340-8039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty