MEDICARE: HEALTH ATLAST WEST LA

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	207R00000X	Internal Medicine Physician
2	208100000X	Physical Medicine & Rehabilitation Physician

General Provider Information

NPI Number	:	1326584277
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTH ATLAST WEST LA

Provider Business Mailing Address
First Line	:	2428 SANTA MONICA BLVD STE 308
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90404-2046
Country	:	US
Telephone Number	:	310-453-8393
Fax Number	:	310-453-8696

Provider Business Practice Location Address
First Line	:	2428 SANTA MONICA BLVD STE 308
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90404-2046
Country	:	US
Telephone Number	:	310-453-8393
Fax Number	:	310-453-8696

Authorized Official
Title or Position	:	OWNER
Name	:	WAYNE HIGASHI
Credential	:	DC
Telephone Number	:	310-390-9018

Provider Enumeration Date	:	01/17/2017
Last Update Date	:	01/17/2017

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Directions to “HEALTH ATLAST WEST LA ” Practice Location

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