Healthcare Provider Details

I. General information

NPI: 1255401444
Provider Name (Legal Business Name): WESTSIDE HOME MEDICAL EQUIPMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2743 S ROBERTSON BLVD
LOS ANGELES CA
90034-2403
US

IV. Provider business mailing address

2743 S ROBERTSON BLVD
LOS ANGELES CA
90034-2403
US

V. Phone/Fax

Practice location:
  • Phone: 310-204-2375
  • Fax: 310-204-2549
Mailing address:
  • Phone: 310-204-2375
  • Fax: 310-204-2549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number100697
License Number StateCA

VIII. Authorized Official

Name: WEHIBA KALIFA
Title or Position: PRESIDENT
Credential:
Phone: 310-204-2375