Healthcare Provider Details

I. General information

NPI: 1699105544
Provider Name (Legal Business Name): WESTERN UNITED MEDICAL CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2013
Last Update Date: 11/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 S AZUSA AVE STE B-5
WEST COVINA CA
91791-4088
US

IV. Provider business mailing address

1414 S AZUSA AVE STE B-6
WEST COVINA CA
91791-4088
US

V. Phone/Fax

Practice location:
  • Phone: 626-917-8706
  • Fax:
Mailing address:
  • Phone: 626-917-8706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License NumberDC23316
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License NumberA448861
License Number StateCA

VIII. Authorized Official

Name: MAHMOUD MATIN
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 626-917-8706