Clementine Malibu Lake | |
29470 Lake Vista Dr Agoura Hills CA 91301-2818 | |
(747) 212-5021 | |
(818) 575-7327 |
Full Name | Clementine Malibu Lake |
---|---|
Speciality | Clinic/center - Adolescent And Children Mental Health |
Location | 29470 Lake Vista Dr, Agoura Hills, California |
Authorized Official Name and Position | Mike Bagley (CHIEF FINANCIAL OFFICER) |
Authorized Official Contact | 3056631876 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Clementine Malibu Lake 6100 Sw 76th St South Miami FL 33143-5002 Ph: (305) 663-1876 | Clementine Malibu Lake 29470 Lake Vista Dr Agoura Hills CA 91301-2818 Ph: (747) 212-5021 |
NPI Number | 1780105551 |
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Provider Enumeration Date | 07/03/2017 |
Last Update Date | 05/27/2020 |
Certification Date | 05/27/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1780105551 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Primary |
News Archive
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