Basic Information
| Provider Information | |||||||||
| NPI: | 1629463120 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WEST COUNTY MEDICAL CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2631 W 48TH ST | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900431420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3239018759 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2272 PACIFIC AVE | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908064312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5624278018 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2015 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | BELL | ||||||||
| AuthorizedOfficialFirstName: | MIGNON | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3233096394 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | CA | Y | Agencies | Case Management |
No ID Information.