Healthcare Provider Details

I. General information

NPI: 1073501664
Provider Name (Legal Business Name): WESTSIDE HEALTH CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 S FAIRFAX AVE
LOS ANGELES CA
90019-4401
US

IV. Provider business mailing address

1020 S FAIRFAX AVE
LOS ANGELES CA
90019-4401
US

V. Phone/Fax

Practice location:
  • Phone: 323-938-2451
  • Fax: 323-938-0361
Mailing address:
  • Phone: 323-938-2451
  • Fax: 323-938-0361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: LYDIA FLORO CRUZ
Title or Position: PRESIDENT
Credential:
Phone: 323-965-0600