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General NPI Number Information
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NPI Number | 1093919615
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Entity Type | Organization
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Legal Business Name | PACIFIC WEST COAST HEALTH MEDICAL THERAPY CENTER INC.
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Dates
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Enumeration Date | 06/14/2007
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Last Update Date | 10/22/2007
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Provider Practice Location Address
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Address Line | 11540 SANTA MONICA BLVD 201
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City | LOS ANGELES
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State | CA
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Zip | 90025-7905
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Country | US
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Telephone | 310-428-8065
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Fax |
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Provider Business Mailing Address
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Address Line | 1441 WESTWOOD BLVD #E
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City | LOS ANGELES
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State | CA
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Zip | 90024-4938
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DESIGNATED CONTACT
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Name | DR. LARRY WIENER
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Credential | D.C.
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Telephone | 310-428-8065
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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