Provider Demographics
NPI:1700169521
Name:PRIORITY FAMILY HEALTH A MEDICAL CORPORATION
Entity type:Organization
Organization Name:PRIORITY FAMILY HEALTH A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PRATIBHA
Authorized Official - Middle Name:
Authorized Official - Last Name:KUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-874-3358
Mailing Address - Street 1:1220 LA VENTA DR
Mailing Address - Street 2:205B
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-3703
Mailing Address - Country:US
Mailing Address - Phone:818-874-3358
Mailing Address - Fax:818-874-3359
Practice Address - Street 1:638 LINDERO CANYON RD
Practice Address - Street 2:244
Practice Address - City:OAK PARK
Practice Address - State:CA
Practice Address - Zip Code:91377-5457
Practice Address - Country:US
Practice Address - Phone:818-874-3358
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-28
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
A40351261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
F32346Medicare UPIN