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1500 W West Covina Pkwy West Covina CA 91790-2707 | |
| (626) 960-8614 | |
| (626) 960-9177 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 1500 W West Covina Pkwy, West Covina, California |
| Authorized Official Name and Position | Kerry Weiner (PRESIDENT) |
| Authorized Official Contact | 8186372000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
777 Flower St Ste A Glendale CA 91201-3000 Ph: (818) 637-2000 | 1500 W West Covina Pkwy West Covina CA 91790-2707 Ph: (626) 960-8614 |
| NPI Number | 1386789311 |
|---|---|
| Provider Enumeration Date | 02/20/2007 |
| Last Update Date | 02/21/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386789311 | NPI | - | NPPES |
| 1101890001 | Other | CA | MEDICARE SUPPLIER |
| GR0105950 | Medicaid | CA |
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