MEDICARE: WILSHIRE VISTA MANOR

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	310400000X	Assisted Living Facility		CA

General Provider Information

NPI Number	:	1427253319
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILSHIRE VISTA MANOR

Provider Business Mailing Address
First Line	:	1015 S ORANGE GROVE AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90019-6510
Country	:	US
Telephone Number	:	323-933-8271
Fax Number	:	323-933-8273

Provider Business Practice Location Address
First Line	:	1015 S ORANGE GROVE AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90019-6510
Country	:	US
Telephone Number	:	323-933-8271
Fax Number	:	323-933-8273

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. SIMIN TEHRANI
Credential	:	RN
Telephone Number	:	323-933-8271

Provider Enumeration Date	:	06/19/2007
Last Update Date	:	08/22/2020

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Directions to “WILSHIRE VISTA MANOR ” Practice Location

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