Healthcare Provider Details

I. General information

NPI: 1255631925
Provider Name (Legal Business Name): WESTERN ACUTE CARE PHYSICIANS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2010
Last Update Date: 11/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2231 S WESTERN AVE
LOS ANGELES CA
90018-1302
US

IV. Provider business mailing address

PO BOX 4419
WOODLAND HILLS CA
91365-4419
US

V. Phone/Fax

Practice location:
  • Phone: 323-373-2250
  • Fax: 818-587-2493
Mailing address:
  • Phone: 818-340-9988
  • Fax: 818-587-2493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN L GLAVINOVICH
Title or Position: PRESIDENT
Credential: MD
Phone: 818-340-9988