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NPI Code Detail

MEDICARE: ONE WEST MEDICAL GROUP, A PROFESSIONAL CORPORATION

MEDICARE: ONE WEST MEDICAL GROUP, A PROFESSIONAL CORPORATION
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
1207R00000XInternal Medicine Physician

General Provider Information

NPI Number : 1548650732
Entity Type Code : Organization
Provider Name (Legal Business Name) : ONE WEST MEDICAL GROUP, A PROFESSIONAL CORPORATION
Provider Business Mailing Address
First Line : PO BOX 894874
Second Line :
City : LOS ANGELES
State : CA
Zip : 90189-4874
Country : US
Telephone Number : 310-553-5203
Fax Number : 310-652-0933
Provider Business Practice Location Address
First Line : 14860 ROSCOE BLVD STE 200
Second Line :
City : PANORAMA CITY
State : CA
Zip : 91402-4683
Country : US
Telephone Number : 310-553-5203
Fax Number : 310-652-0933
Authorized Official
Title or Position : MANAGER
Name : DR. ASHLEY ALFRED WOOL-SMITH
Credential : DC
Telephone Number : 310-553-5203
Provider Enumeration Date : 01/27/2015
Last Update Date : 01/19/2017

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Directions to “ONE WEST MEDICAL GROUP, A PROFESSIONAL CORPORATION ” Practice Location

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