| 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 |
|---|---|
| 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 |
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