Organization
RANCHO DEL CIELO MALIBU
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SPARKY GREENE (CEO)
(310) 344-5558
Entity
Organization
Contact information
Practice address
5591 DE BUTTS TER, MALIBU, CA 90265-1709
(310) 589-9398
Mailing address
PO BOX 6704, MALIBU, CA 90264-6704
(310) 589-9398
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
261QC1500X
Community Health Clinic/Center
—
—
261QC1800X
Corporate Health Clinic/Center
—
—
261QH0100X
Health Service Clinic/Center
—
—
Other
Enumeration date
11/14/2013
Last updated
11/14/2013
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