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
1	111N00000X	Chiropractor
2	207R00000X	Internal Medicine Physician
3	208100000X	Physical Medicine & Rehabilitation Physician

General Provider Information

NPI Number	:	1548658966
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTH ATLAST WEST LA

Provider Business Mailing Address
First Line	:	3030 SAWTELLE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-1408
Country	:	US
Telephone Number	:	310-390-9018
Fax Number	:

Provider Business Practice Location Address
First Line	:	14417 BURBANK BLVD
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91401-4824
Country	:	US
Telephone Number	:	818-786-5985
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	WAYNE HIGASHI
Credential	:
Telephone Number	:	31039090108

Provider Enumeration Date	:	01/07/2015
Last Update Date	:	01/07/2015

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Directions to “HEALTH ATLAST WEST LA ” Practice Location

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