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General NPI Number Information
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NPI Number | 1255364998
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Entity Type | Organization
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Legal Business Name | WEST COAST CARDIOLOGY MEDICAL GROUP INC.
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Dates
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Enumeration Date | 07/08/2006
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Last Update Date | 12/17/2007
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Provider Practice Location Address
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Address Line | 575 E HARDY ST SUITE 104
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City | INGLEWOOD
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State | CA
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Zip | 90301-4036
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Country | US
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Telephone | 310-671-9802
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Fax | 310-671-5011
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Provider Business Mailing Address
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Address Line | 575 E HARDY ST SUITE 104
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City | INGLEWOOD
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State | CA
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Zip | 90301-4036
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Country | US
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Telephone | 310-671-9802
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Fax | 310-671-5011
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. ANNA BALL
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Credential |
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Telephone | 310-671-9802
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | A33600
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License Number State | CA
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