Organization · NPI-2

Atlantic Cove Medical Group

Family Medicine · Woodland Hills, CA

NPI number1649093097

StatusActive

Last updated in NPPESNov 4, 2024

Details

NPI: 1649093097
Entity type: Organization (NPI-2)
Legal business name: Atlantic Cove Medical Group
Organization subpart: No
Enumeration date: Nov 4, 2024
Certification date: Nov 4, 2024
Last updated: Nov 4, 2024

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
207Q00000X	Family Medicine	–	–	Yes
207R00000X	Internal Medicine	–	–
261Q00000X	Clinic/Center	–	–
261QM1300X	Clinic/Center, Multi-Specialty	–	–

Practice location

22141 Ventura Blvd Ste 300
Woodland Hills, CA 91364-5734

Phone 941-208-3070 · Fax 941-208-3070

Mailing address

5342 Clark Rd # 3072
Sarasota, FL 34233-3227

Phone 941-208-3070

Authorized official

Collins Ezeuka
Ceo, Cmo, Founder
9412083070

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