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General NPI Number Information
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NPI Number | 1669795431
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Entity Type | Organization
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Legal Business Name | WILSHIRE MEDICAL CLINIC
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Dates
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Enumeration Date | 03/09/2010
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Last Update Date | 03/09/2010
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Provider Practice Location Address
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Address Line | 3540 WILSHIRE BLVD SUITE: 1014
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City | LOS ANGELES
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State | CA
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Zip | 90010-2307
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Country | US
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Telephone | 213-387-8024
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Fax | 213-387-8916
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Provider Business Mailing Address
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Address Line | 3540 WILSHIRE BLVD SUITE: 1014
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City | LOS ANGELES
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State | CA
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Zip | 90010-2307
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Country | US
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Telephone | 213-387-8024
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Fax | 213-387-8916
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | ARTIS WOODWARD
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Credential | M.D.
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Telephone | 213-387-8402
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204C00000X
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Taxonomy Name | Sports Medicine (Neuromusculoskeletal Medicine) Physician
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License Number | A102066
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | A40408
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | A10037
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | G36302
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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