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General NPI Number Information
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NPI Number | 1538351432
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Entity Type | Organization
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Legal Business Name | VENICE NEWBURY MEDICAL CLINIC
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Dates
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Enumeration Date | 08/14/2007
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Last Update Date | 11/13/2012
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Provider Practice Location Address
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Address Line | 3701 STOCKER ST SUITE 100
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City | LOS ANGELES
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State | CA
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Zip | 90008-5108
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Country | US
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Telephone | 323-290-6400
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Fax | 323-290-6403
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Provider Business Mailing Address
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Address Line | PO BOX 45407
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City | LOS ANGELES
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State | CA
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Zip | 90045-0407
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Country | US
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Telephone | 323-290-6400
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Fax | 323-290-6403
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. CUTHBERT WESTON PYNE
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Credential | MD
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Telephone | 323-290-6400
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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 | A29958
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License Number State | CA
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