Cliffside Malibu Outpatient Services

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

License

190078AP Issued in CA

Legal business name

CLIFFSIDE MALIBU OUTPATIENT SERVICES

Practice address

29160 Heathercliff Rd., Ste. 100
Malibu, CA 90265

Phone

(424) 781-4748

NPI assigned

Oct 17, 2014

Last updated

Nov 14, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Magdalen Gustilo

Title

Director of Payer Relations

Phone

(714) 568-7667

Specialties & licenses 2

Addresses

Other names 1

• Cliffside Malibu IOP Former legal business name

Locations

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

{
    "created_epoch": "1413504000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699920000000",
    "number": "1164826210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18401 VON KARMAN AVE STE 500",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926128531",
            "telephone_number": "714-828-1800",
            "fax_number": "714-882-1186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29160 HEATHERCLIFF RD., STE. 100",
            "city": "MALIBU",
            "state": "CA",
            "postal_code": "90265",
            "telephone_number": "424-781-4748"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLIFFSIDE MALIBU OUTPATIENT SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-17",
        "last_updated": "2023-11-14",
        "certification_date": "2023-11-14",
        "status": "A",
        "authorized_official_last_name": "GUSTILO",
        "authorized_official_first_name": "MAGDALEN",
        "authorized_official_title_or_position": "DIRECTOR OF PAYER RELATIONS",
        "authorized_official_telephone_number": "714-568-7667"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "CA",
            "license": "190815A",
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "CA",
            "license": "190078AP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cliffside Malibu IOP",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Cliffside Malibu IOP",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Jessica Rae Clark, LMFT
• Cliffside Malibu
• Cliffside Malibu 1 (Horizon Hills)
• Cliffside Malibu 3
• Cliffside Malibu II
• Harry G. Cohen, M.D.
• Colony Care Partners
• Meg Conboy, MSN, FNP-BC
• Conscientia Recovery Center
• Barbara Rosengrant Copeland, M.S. CCC/SLP

• Substance Use Disorder Rehabilitation Clinic/Center in Malibu, CA
• Providers in Malibu, CA by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2023; 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.