Crestwood, Inc.

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

A76279 Issued in CA

Legal business name

CRESTWOOD, INC.

Practice address

4910 Van Nuys Blvd
Suite #308
Sherman Oaks, CA 91403-1715

Phone

(818) 986-9099

Fax

(818) 986-9089

NPI assigned

Mar 10, 2015

Organization subpart

No

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

Authorized official

Name

Sameer Malhotra, M.D.

Title

President

Phone

(818) 986-9099

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1425945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1425945600000",
    "number": "1962895250",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4910 VAN NUYS BLVD",
            "address_2": "SUITE #308",
            "city": "SHERMAN OAKS",
            "state": "CA",
            "postal_code": "914031715",
            "telephone_number": "818-986-9099",
            "fax_number": "818-986-9089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4910 VAN NUYS BLVD",
            "address_2": "SUITE #308",
            "city": "SHERMAN OAKS",
            "state": "CA",
            "postal_code": "914031715",
            "telephone_number": "818-986-9099",
            "fax_number": "818-986-9089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRESTWOOD, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-10",
        "last_updated": "2015-03-10",
        "status": "A",
        "authorized_official_last_name": "MALHOTRA",
        "authorized_official_first_name": "SAMEER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "818-986-9099",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Urology",
            "state": "CA",
            "license": "A76279",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A762790",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2015; 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.