Malibu Canyon Rehab Corporation

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

MALIBU CANYON REHAB CORPORATION

Practice address

4505 Las Virgenes Road
Suite 207
Calabasas, CA 91302

Phone

(818) 878-6900

Fax

(818) 878-6902

NPI assigned

Jun 27, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Arielle Penn, LCSW

Title

Program Director

Phone

(310) 740-1373

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1340755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1340755200000",
    "number": "1013271808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4505 LAS VIRGENES ROAD",
            "address_2": "SUITE 207",
            "city": "CALABASAS",
            "state": "CA",
            "postal_code": "91302",
            "telephone_number": "818-878-6900",
            "fax_number": "818-878-6902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4505 LAS VIRGENES ROAD",
            "address_2": "SUITE 207",
            "city": "CALABASAS",
            "state": "CA",
            "postal_code": "91302",
            "telephone_number": "818-878-6900",
            "fax_number": "818-878-6902"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MALIBU CANYON REHAB CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-27",
        "last_updated": "2012-06-27",
        "status": "A",
        "authorized_official_last_name": "PENN",
        "authorized_official_first_name": "ARIELLE",
        "authorized_official_title_or_position": "PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "310-740-1373",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mehdi Mahmoodzadegan, M.D.
• Ksenia Maksimova, NP-BC
• Naysan Malakouti-Nejad
• Haleh Malek, PSYD
• Malibu Balance Day Treatment
• Malibu Canyon Urgent Care LLC
• Irving Malis, M.D.
• Jonathan Malka
• Leeanne Sacks Mallel, CCC-SLP
• Ronald Mancini, MD

• Clinic/Center in Calabasas, CA
• Providers in Calabasas, CA by specialty
• Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.