1619105947 NPI number — WEST COAST OUTPATIENT SERVICES, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619105947 NPI number — WEST COAST OUTPATIENT SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEST COAST OUTPATIENT SERVICES, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619105947
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/12/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
727 LOYOLA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARSON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90746-3903
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-350-9852
Provider Business Mailing Address Fax Number:
310-675-7701

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13252 HAWTHORNE BLVD
Provider Second Line Business Practice Location Address:
103
Provider Business Practice Location Address City Name:
HAWTHORNE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90250-5816
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-350-9852
Provider Business Practice Location Address Fax Number:
310-675-7701
Provider Enumeration Date:
06/25/2009

Additional Information

Authorized Official

Authorized Official Last Name:
OKEKE
Authorized Official First Name:
JONES
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
310-350-9852

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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