Healthcare Provider Details

I. General information

NPI: 1902906068
Provider Name (Legal Business Name): WESTERN HEALTH CARE, A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 03/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4760 S FIGUEROA ST
LOS ANGELES CA
90037-3159
US

IV. Provider business mailing address

4035 DAVANA RD
SHERMAN OAKS CA
91423-4635
US

V. Phone/Fax

Practice location:
  • Phone: 323-232-2601
  • Fax: 323-232-1924
Mailing address:
  • Phone: 323-232-2601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. VEASSA GAIL JOHNSON
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 323-232-2601