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NPI Code Detail

MEDICARE: CRESCENTA FAMILY MEDICAL, INC.

MEDICARE: CRESCENTA FAMILY MEDICAL, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialistDC18169CA

General Provider Information

NPI Number : 1548325228
Entity Type Code : Organization
Provider Name (Legal Business Name) : CRESCENTA FAMILY MEDICAL, INC.
Provider Business Mailing Address
First Line : 2048 MONTROSE AVE
Second Line :
City : MONTROSE
State : CA
Zip : 91020-1605
Country : US
Telephone Number : 818-957-7612
Fax Number :
Provider Business Practice Location Address
First Line : 2048 MONTROSE AVE
Second Line :
City : MONTROSE
State : CA
Zip : 91020-1605
Country : US
Telephone Number : 818-957-7612
Fax Number :
Authorized Official
Title or Position : SECRETARY
Name : DR. GARY T. WECKBACHER
Credential : D.C.
Telephone Number : 818-957-7612
Provider Enumeration Date : 12/24/2006
Last Update Date : 08/22/2020

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Directions to “CRESCENTA FAMILY MEDICAL, INC. ” Practice Location

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