Healthcare Provider Details

I. General information

NPI: 1144789660
Provider Name (Legal Business Name): WEST COAST MULTI MEDICAL SPECIALTY CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2019
Last Update Date: 03/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13071 BROOKHURST ST STE 170
GARDEN GROVE CA
92843-1061
US

IV. Provider business mailing address

13071 BROOKHURST ST STE 170
GARDEN GROVE CA
92843-1061
US

V. Phone/Fax

Practice location:
  • Phone: 562-860-2442
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. AMABLE R. AGUILUZ JR.
Title or Position: PRESIDENT/CEO
Credential: M.D.
Phone: 562-822-3776