Provider Demographics
NPI:1164848180
Name:WEST PHYSICIANS MEDICAL
Entity Type:Organization
Organization Name:WEST PHYSICIANS MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:T
Authorized Official - Last Name:HERICO
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:650-580-9827
Mailing Address - Street 1:9939 MAGNOLIA AVENUE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503
Mailing Address - Country:US
Mailing Address - Phone:951-687-8802
Mailing Address - Fax:
Practice Address - Street 1:5810 REDHAVEN ST
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92880-3132
Practice Address - Country:US
Practice Address - Phone:650-580-9827
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-14
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care