Healthcare Provider Details

I. General information

NPI: 1285634527
Provider Name (Legal Business Name): WEST OAKS CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18368 CLARK ST
TARZANA CA
91356-3502
US

IV. Provider business mailing address

18368 CLARK ST
TARZANA CA
91356-3502
US

V. Phone/Fax

Practice location:
  • Phone: 818-881-5300
  • Fax: 818-881-5410
Mailing address:
  • Phone: 818-881-5300
  • Fax: 818-881-5410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License NumberPHY42131
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHY42131
License Number StateCA

VIII. Authorized Official

Name: MR. GREGORY VAYBERMAN
Title or Position: PRESIDENT
Credential:
Phone: 818-881-5300