1962714709 NPI number — WEST COAST WOUND CARE, 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 1962714709 NPI number — WEST COAST WOUND CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEST COAST WOUND CARE, 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:
1962714709
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
976 MCLEAN AVE
Provider Second Line Business Mailing Address:
SUITE 387
Provider Business Mailing Address City Name:
YONKERS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10704-4105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-237-6797
Provider Business Mailing Address Fax Number:
208-279-8681

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
181 EAST FIRST STREET
Provider Second Line Business Practice Location Address:
SUITE 900
Provider Business Practice Location Address City Name:
SANTA ANA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92705-4066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-237-6797
Provider Business Practice Location Address Fax Number:
208-279-8681
Provider Enumeration Date:
07/09/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BUNKER
Authorized Official First Name:
CRAIG
Authorized Official Middle Name:
Authorized Official Title or Position:
OPERATIONS
Authorized Official Telephone Number:
914-237-6797

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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