Healthcare Provider Details

I. General information

NPI: 1720278138
Provider Name (Legal Business Name): OCCUPATIONAL MEDICINE CENTER OF WEST JEFFERSON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 08/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4475 WESTBANK EXPY
MARRERO LA
70072-3102
US

IV. Provider business mailing address

3607 OLD CONEJO RD
THOUSAND OAKS CA
91320-2123
US

V. Phone/Fax

Practice location:
  • Phone: 504-347-8471
  • Fax:
Mailing address:
  • Phone: 805-375-0800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License NumberBW4947454
License Number StateLA

VIII. Authorized Official

Name: DR. TSAO TE WEI
Title or Position: PHYSICIAN
Credential:
Phone: 504-347-8471