CLEMENTINE MALIBU LAKE
NPI 1780105551
Clinic/Center - Adolescent and Children Mental Health in Agoura Hills, CA

Q: What is Monte Nido Lake Vista, LLC's NPI number?

The NPI number for Monte Nido Lake Vista, LLC is 1780105551. It was assigned to this organization in the NPPES registry on July 3, 2017. The provider is doing business as Clementine Malibu Lake.

Q: What is Monte Nido Lake Vista, LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Adolescent and Children Mental Health, with taxonomy code 261QM0855X.

Active since July 03, 2017CLIA 05D2159905 · Waiver

29470 LAKE VISTA DR, AGOURA HILLS, CA 91301(747) 212-5021(818) 575-7327 Get Directions Write a Review

NPPES record last updated: May 27, 2020. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: May 27, 2020, Jul 3, 2017 (2 updates tracked since 2017).

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About Clementine Malibu Lake NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CLEMENTINE MALIBU LAKE (NPI 1780105551) is a healthcare organization registered as an adolescent and children mental health in Agoura Hills, California and active in the NPI registry since July 2017. The organization holds a CLIA Waiver certificate valid through December 30, 2026 and lists Mike Bagley, Chief Financial Officer, as its authorized official.

NPPES Registry Identity

NPI1780105551

Entity TypeOrganization

Primary Taxonomy261QM0855X

Legal Business NameMONTE NIDO LAKE VISTA, LLC

Location Address29470 LAKE VISTA DRAgoura Hills, CA 91301-2818

Mailing Address6100 Sw 76th StSouth Miami, FL 33143-5002 · (305) 663-1876 · Fax (786) 359-4485

Phone(747) 212-5021

Fax(818) 575-7327

Organization SubpartYes

Authorized OfficialMike BagleyChief Financial Officer · (305) 663-1876

Enumeration DateJuly 3, 2017

Last NPPES UpdateMay 27, 20202 updates tracked since enumeration

NPPES CertifiedMay 27, 2020

✔ NPI 1780105551 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Adolescent and Children Mental HealthAmbulatory Health Care Facilities

Taxonomy Code261QM0855X

Definition

An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in children and adolescents. Services may be provided to parents and family members of the patient in the form of conjoint, group, or individual therapy, and education and/or training.

29470 LAKE VISTA DR, Agoura Hills, CA 91301

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Other Names 1

Doing Business AsClementine Malibu Lake

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Kaiser Permanente.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 05D2159905

Clementine Malibu Lake · Agoura Hills, CA

Active · expires Dec 30, 2026

CLIA Number05D2159905

Laboratory TypeResidential Mental Hlth

Certificate Effective DateDecember 31, 2024

Certificate Expiration DateDecember 30, 2026

Laboratory DirectorMolly M. Perlman

Laboratory Phone(747) 212-5021

Laboratory LocationClementine Malibu Lake29470 Lake Vista Dr, Agoura Hills, CA 91301

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

OLIVIA ANN SCHOENECKER LCSW

Social Worker (Clinical)

29470 LAKE VISTA DR
AGOURA HILLS, CA 91301

Los Angeles County (747) 212-5021

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Monte Nido Lake Vista, LLC's NPI number?

The NPI number for Monte Nido Lake Vista, LLC is 1780105551. It was assigned to this organization in the NPPES registry on July 3, 2017. The provider is doing business as Clementine Malibu Lake.

Where is Monte Nido Lake Vista, LLC located?

Monte Nido Lake Vista, LLC is located at 29470 Lake Vista Dr, Agoura Hills, CA 91301. The listed phone number is (747) 212-5021.

What is Monte Nido Lake Vista, LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Adolescent and Children Mental Health, with taxonomy code 261QM0855X.

Does Monte Nido Lake Vista, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 05D2159905) is associated with this NPI, valid through December 30, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Monte Nido Lake Vista, LLC accept?

Health plans from Kaiser Permanente list Monte Nido Lake Vista, LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Monte Nido Lake Vista, LLC was last updated on May 27, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.