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General NPI Number Information
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NPI Number | 1164848180
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Entity Type | Organization
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Legal Business Name | WEST PHYSICIANS MEDICAL
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Dates
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Enumeration Date | 03/14/2014
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Last Update Date | 03/14/2014
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Provider Practice Location Address
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Address Line | 5810 REDHAVEN ST
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City | CORONA
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State | CA
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Zip | 92880-3132
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Country | US
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Telephone | 650-580-9827
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Fax |
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Provider Business Mailing Address
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Address Line | 9939 MAGNOLIA AVENUE
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City | RIVERSIDE
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State | CA
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Zip | 92503
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Country | US
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Telephone | 951-687-8802
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | JANE T HERICO
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Credential | NP
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Telephone | 650-580-9827
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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