Healthcare Provider Details

I. General information

NPI: 1467096032
Provider Name (Legal Business Name): WEST COAST MEDICAL HEALTH SERVICES A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2019
Last Update Date: 11/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1082 GLENDON AVE
LOS ANGELES CA
90024-2908
US

IV. Provider business mailing address

210 N TUSTIN AVE
SANTA ANA CA
92705-3807
US

V. Phone/Fax

Practice location:
  • Phone: 310-209-2011
  • Fax:
Mailing address:
  • Phone: 714-347-1000
  • Fax: 714-647-1245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MAHATHEP SRIKUREJA
Title or Position: PRESIDENT
Credential: MD
Phone: 626-235-5925