MEDICARE: JM WEST COAST 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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1760695936
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JM WEST COAST INC

Provider Business Mailing Address
First Line	:	13505 SUMMIT AVE
Second Line	:	SUITE 2
City	:	TAMPA
State	:	FL
Zip	:	33613-3326
Country	:	US
Telephone Number	:	813-514-3716
Fax Number	:	813-654-4278

Provider Business Practice Location Address
First Line	:	13505 SUMMIT AVE
Second Line	:	SUITE 2
City	:	TAMPA
State	:	FL
Zip	:	33613-3326
Country	:	US
Telephone Number	:	813-514-3716
Fax Number	:	813-654-4278

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. JOSE Y MARTIN
Credential	:
Telephone Number	:	813-514-3716

Provider Enumeration Date	:	05/07/2007
Last Update Date	:	08/22/2020

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Directions to “JM WEST COAST INC ” Practice Location

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