Provider Demographics
NPI:1184975948
Name:1.JILL FURGURSON, M.D., INC.
Entity type:Organization
Organization Name:1.JILL FURGURSON, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JILL
Authorized Official - Middle Name:E
Authorized Official - Last Name:FURGURSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-710-7761
Mailing Address - Street 1:23941 DE VILLE WAY
Mailing Address - Street 2:
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-4894
Mailing Address - Country:US
Mailing Address - Phone:818-710-7761
Mailing Address - Fax:
Practice Address - Street 1:23656 PACIFIC COAST HWY
Practice Address - Street 2:
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-4800
Practice Address - Country:US
Practice Address - Phone:310-456-7551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG36815261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care