| Pacific West Coast Health Medical Therapy Center Inc. | |
|
11540 Santa Monica Blvd 201 Los Angeles CA 90025-7905 | |
| (310) 428-8065 | |
| Not Available |
| Full Name | Pacific West Coast Health Medical Therapy Center Inc. |
|---|---|
| Speciality | Family Medicine |
| Location | 11540 Santa Monica Blvd, Los Angeles, California |
| Authorized Official Name and Position | Larry Wiener (DESIGNATED CONTACT) |
| Authorized Official Contact | 3104288065 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pacific West Coast Health Medical Therapy Center Inc. 1441 Westwood Blvd #e Los Angeles CA 90024-4938 Ph: () - | Pacific West Coast Health Medical Therapy Center Inc. 11540 Santa Monica Blvd 201 Los Angeles CA 90025-7905 Ph: (310) 428-8065 |
| NPI Number | 1093919615 |
|---|---|
| Provider Enumeration Date | 06/14/2007 |
| Last Update Date | 10/22/2007 |
| Medicare PECOS PAC ID | 4688756869 |
|---|---|
| Medicare Enrollment ID | O20080126000136 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093919615 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Rodney Collins |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1700879061 PECOS PAC ID: 1052219649 Enrollment ID: I20041020001255 |
| Provider Name | Susan V Massey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962731240 PECOS PAC ID: 2466583786 Enrollment ID: I20160122001524 |
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