Healthcare Provider Details

I. General information

NPI: 1083954366
Provider Name (Legal Business Name): WEST COAST MEDICAL MANAGEMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2013
Last Update Date: 02/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2279 AGATE CT
SIMI VALLEY CA
93065-1843
US

IV. Provider business mailing address

2279 AGATE CT
SIMI VALLEY CA
93065-1843
US

V. Phone/Fax

Practice location:
  • Phone: 805-581-2279
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: ROBERT FEATHERS
Title or Position: OWNER
Credential:
Phone: 805-581-2279