Provider Demographics
NPI:1841368818
Name:TOPANGA MEDICAL CLINIC
Entity type:Organization
Organization Name:TOPANGA MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:PENDLETON
Authorized Official - Last Name:ROY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-455-2019
Mailing Address - Street 1:395 S TOPANGA CANYON BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:TOPANGA
Mailing Address - State:CA
Mailing Address - Zip Code:90290-3143
Mailing Address - Country:US
Mailing Address - Phone:310-455-2019
Mailing Address - Fax:310-455-2010
Practice Address - Street 1:395 S TOPANGA CANYON BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:TOPANGA
Practice Address - State:CA
Practice Address - Zip Code:90290-3143
Practice Address - Country:US
Practice Address - Phone:310-455-2019
Practice Address - Fax:310-455-2010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG-037170261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW1782Medicare ID - Type Unspecified
CAA46982Medicare UPIN