Provider Demographics
NPI:1114311370
Name:CLINICAL RESEARCH WEST COAST.INC
Entity Type:Organization
Organization Name:CLINICAL RESEARCH WEST COAST.INC
Other - Org Name:CLINICAL RESEARCH WEST COAST.INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:RICARDO
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-665-0430
Mailing Address - Street 1:3660 CENTRAL AVE STE 9
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-8258
Mailing Address - Country:US
Mailing Address - Phone:239-208-9677
Mailing Address - Fax:239-208-9679
Practice Address - Street 1:3660 CENTRAL AVE STE 9
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-8258
Practice Address - Country:US
Practice Address - Phone:239-208-9677
Practice Address - Fax:239-208-9679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-26
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherEIN