Healthcare Provider Details

I. General information

NPI: 1427435510
Provider Name (Legal Business Name): WASCO MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2015
Last Update Date: 04/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1149 7TH ST
WASCO CA
93280-1819
US

IV. Provider business mailing address

1149 7TH ST
WASCO CA
93280-1819
US

V. Phone/Fax

Practice location:
  • Phone: 661-758-2449
  • Fax: 661-758-8317
Mailing address:
  • Phone: 661-758-2449
  • Fax: 661-758-8317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberNP95001924
License Number StateCA

VIII. Authorized Official

Name: MR. REMIGIO PAREDES
Title or Position: OWNER
Credential:
Phone: 661-758-2449