Healthcare Provider Details

I. General information

NPI: 1568577161
Provider Name (Legal Business Name): WEST COAST MEDICAL DIAGNOSTIC SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4311 WILSHIRE BLVD 512
LOS ANGELES CA
90010-3708
US

IV. Provider business mailing address

4311 WILSHIRE BLVD 512
LOS ANGELES CA
90010-3708
US

V. Phone/Fax

Practice location:
  • Phone: 323-938-6559
  • Fax:
Mailing address:
  • Phone: 323-938-6559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: EDWARD WALDMAN
Title or Position: PRESIDENT
Credential:
Phone: 323-938-6559