MEDICARE: WESTIN ENTERPRISES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA0600X	Adult Day Care Clinic/Center		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ADU70130G	OTHER	CA	PROVIDER NUMBER

General Provider Information

NPI Number	:	1013058726
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTIN ENTERPRISES, INC.

Provider Business Mailing Address
First Line	:	23517 MAIN ST
Second Line	:	SUITE 110
City	:	CARSON
State	:	CA
Zip	:	90745-5251
Country	:	US
Telephone Number	:	310-522-3860
Fax Number	:

Provider Business Practice Location Address
First Line	:	23517 MAIN ST
Second Line	:	SUITE 110
City	:	CARSON
State	:	CA
Zip	:	90745-5251
Country	:	US
Telephone Number	:	310-522-3860
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	EVELYN ANDAMO
Credential	:	OTR
Telephone Number	:	310-522-3860

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	08/22/2020

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