Provider Demographics
NPI:1265121446
Name:CONEJO VALLEY PRIMARY HEALTHCARE
Entity type:Organization
Organization Name:CONEJO VALLEY PRIMARY HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:COATES-LEISEN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:818-642-7162
Mailing Address - Street 1:1429 E THOUSAND OAKS BLVD # 108
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-2801
Mailing Address - Country:US
Mailing Address - Phone:805-719-1700
Mailing Address - Fax:805-719-1711
Practice Address - Street 1:1429 E THOUSAND OAKS BLVD # 108
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91362-2801
Practice Address - Country:US
Practice Address - Phone:805-719-1700
Practice Address - Fax:805-719-1711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-03
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service