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General NPI Number Information
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NPI Number | 1932300944
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Entity Type | Organization
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Legal Business Name | WEST COAST ENDOCRINE A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 05/29/2007
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Last Update Date | 01/22/2018
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Provider Practice Location Address
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Address Line | 5500 E ATHERTON ST SUITE 416
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City | LONG BEACH
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State | CA
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Zip | 90815-4016
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Country | US
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Telephone | 562-988-0040
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Fax | 562-988-0041
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Provider Business Mailing Address
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Address Line | 5500 E ATHERTON ST SUITE 416
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City | LONG BEACH
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State | CA
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Zip | 90815-4016
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Country | US
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Telephone | 562-988-0040
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Fax | 562-988-0041
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER CONNELLY
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Credential | DO
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Telephone | 562-988-0040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | W17025
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | W17025
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License Number State | CA
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