Provider Demographics
NPI:1144789660
Name:WEST COAST MULTI MEDICAL SPECIALTY CLINIC INC
Entity Type:Organization
Organization Name:WEST COAST MULTI MEDICAL SPECIALTY CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:AMABLE
Authorized Official - Middle Name:R
Authorized Official - Last Name:AGUILUZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:562-822-3776
Mailing Address - Street 1:13071 BROOKHURST ST STE 170
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-1061
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13071 BROOKHURST ST STE 170
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-1061
Practice Address - Country:US
Practice Address - Phone:562-860-2442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-14
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty