Provider Demographics
NPI:1003347485
Name:MENS HEALTH CENTER OF AMERICA WDC LLC
Entity Type:Organization
Organization Name:MENS HEALTH CENTER OF AMERICA WDC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:L
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-562-4048
Mailing Address - Street 1:23275 S POINTE DR
Mailing Address - Street 2:100
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1474
Mailing Address - Country:US
Mailing Address - Phone:949-200-6612
Mailing Address - Fax:949-258-5076
Practice Address - Street 1:1100 H ST NW
Practice Address - Street 2:650
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20005-5476
Practice Address - Country:US
Practice Address - Phone:202-419-1840
Practice Address - Fax:202-419-1842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD00041583174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty