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General NPI Number Information
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NPI Number | 1689189664
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Entity Type | Organization
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Legal Business Name | WEST COAST DME & SUPPLIES LLC
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Dates
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Enumeration Date | 12/12/2017
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Last Update Date | 12/12/2017
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Provider Practice Location Address
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Address Line | 30101 AGOURA CT STE 114
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City | AGOURA HILLS
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State | CA
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Zip | 91301-4301
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Country | US
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Telephone | 909-477-3117
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Fax | 909-303-9244
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Provider Business Mailing Address
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Address Line | 1835 CHICAGO AVE STE A
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City | RIVERSIDE
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State | CA
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Zip | 92507-2309
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Country | US
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Telephone | 909-477-3117
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Fax |
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Authorized Official
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Title or Position | COO
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Name | MR. MICHAEL GREGORY WELLS
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Credential | CPED
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Telephone | 909-477-3117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 77673
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State | CA
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