Healthcare Provider Details

I. General information

NPI: 1891123782
Provider Name (Legal Business Name): FLORENCE WESTERN MEDICAL CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2013
Last Update Date: 10/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15216 VANOWEN ST SUITE 2C
VAN NUYS CA
91405-3601
US

IV. Provider business mailing address

15216 VANOWEN ST SUITE 2C
VAN NUYS CA
91405-3601
US

V. Phone/Fax

Practice location:
  • Phone: 213-840-2356
  • Fax:
Mailing address:
  • Phone: 213-840-2356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA52385
License Number StateCA

VIII. Authorized Official

Name: DR. KEVIN THOMAS
Title or Position: OWNER
Credential: MD
Phone: 323-778-2131