Organization
VICI PERFORMANCE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAUL MIRANDA (FOUNDER)
(805) 760-2700
Entity
Organization
Contact information
Practice address
28631 CANWOOD ST, AGOURA HILLS, CA 91301-3213
(818) 923-7555
Mailing address
28631 CANWOOD ST, AGOURA HILLS, CA 91301-3213
(818) 923-7555
Taxonomy
Speciality
Code
Description
License number
State
261QR0800X
Recovery Care Clinic/Center
Primary
—
—
Other
Enumeration date
07/03/2022
Last updated
07/10/2022
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