Healthcare Provider Details

I. General information

NPI: 1417223660
Provider Name (Legal Business Name): WEST COAST MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2012
Last Update Date: 03/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17852 MALDEN ST
NORTHRIDGE CA
91325-3816
US

IV. Provider business mailing address

PO BOX 280582
NORTHRIDGE CA
91328-0582
US

V. Phone/Fax

Practice location:
  • Phone: 818-701-1800
  • Fax: 818-885-1171
Mailing address:
  • Phone: 818-701-1800
  • Fax: 818-885-1171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. WENDY MORLEY
Title or Position: BILLER/COLLECTOR
Credential:
Phone: 818-701-1800