Provider Demographics
NPI:1538377171
Name:COMMUNITY MEDICAL GROUP
Entity type:Organization
Organization Name:COMMUNITY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SIEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-707-9603
Mailing Address - Street 1:30125 WEST AGOURA RD #200
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301
Mailing Address - Country:US
Mailing Address - Phone:818-707-9603
Mailing Address - Fax:
Practice Address - Street 1:30125 WEST AGOURA RD #200
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301
Practice Address - Country:US
Practice Address - Phone:818-707-9603
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered302R00000XManaged Care OrganizationsHealth Maintenance Organization
Not Answered305S00000XManaged Care OrganizationsPoint of Service