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NPI Code Detail

MEDICARE: GARY AND MARY WEST SENIOR SERVICES, INC.

MEDICARE: GARY AND MARY WEST SENIOR SERVICES, 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
1251T00000XPACE Provider Organization

General Provider Information

NPI Number : 1295249035
Entity Type Code : Organization
Provider Name (Legal Business Name) : GARY AND MARY WEST SENIOR SERVICES, INC.
Provider Business Mailing Address
First Line : 1706 DESCANSO AVE
Second Line :
City : SAN MARCOS
State : CA
Zip : 92078-2514
Country : US
Telephone Number : 760-280-2230
Fax Number :
Provider Business Practice Location Address
First Line : 1706 DESCANSO AVE
Second Line :
City : SAN MARCOS
State : CA
Zip : 92078-2514
Country : US
Telephone Number : 858-412-7000
Fax Number :
Authorized Official
Title or Position : QI AND COMPLIANCE DIRECTOR
Name : KANNAMMA KANNAN
Credential :
Telephone Number : 760-280-2232
Provider Enumeration Date : 11/30/2017
Last Update Date : 12/10/2019

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Directions to “GARY AND MARY WEST SENIOR SERVICES, INC. ” Practice Location

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