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General NPI Number Information
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NPI Number | 1073272613
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Entity Type | Organization
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Legal Business Name | WEST COAST MEDICAL LABS INC
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Dates
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Enumeration Date | 12/10/2021
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Last Update Date | 12/02/2024
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Provider Practice Location Address
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Address Line | 520 E CENTER ST STE 103
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City | MANTECA
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State | CA
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Zip | 95336-4720
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Country | US
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Telephone | 872-325-6375
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Fax |
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Provider Business Mailing Address
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Address Line | 520 E CENTER ST STE 103
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City | MANTECA
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State | CA
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Zip | 95336-4720
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Country | US
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Telephone | 872-325-6375
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ABDUL G MOHAMMED
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Credential |
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Telephone | 872-325-6375
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 246RM2200X
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Taxonomy Name | Medical Laboratory Technician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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