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General NPI Number Information
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NPI Number | 1679162747
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Entity Type | Organization
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Legal Business Name | WEST COAST MEDICAL CLINIC INC
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Dates
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Enumeration Date | 01/13/2021
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Last Update Date | 01/13/2021
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Provider Practice Location Address
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Address Line | 1703 N AVALON BLVD
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City | WILMINGTON
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State | CA
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Zip | 90744-1432
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Country | US
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Telephone | 310-923-3030
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Fax |
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Provider Business Mailing Address
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Address Line | 230 N MARYLAND AVE STE 110
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City | GLENDALE
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State | CA
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Zip | 91206-4283
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Country | US
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Telephone | 310-923-3030
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CRISTAL DAWN SPELLER RICCI
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Credential | MD
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Telephone | 310-923-3030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number |
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License Number State |
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