Provider Demographics
NPI:1366478992
Name:WESTLAKE MEDICAL MANAGEMENT INC.
Entity Type:Organization
Organization Name:WESTLAKE MEDICAL MANAGEMENT INC.
Other - Org Name:WESTLAKE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLUMKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-383-4262
Mailing Address - Street 1:529 S ALVARADO ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-2903
Mailing Address - Country:US
Mailing Address - Phone:213-383-4262
Mailing Address - Fax:213-383-4263
Practice Address - Street 1:529 S ALVARADO ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-2903
Practice Address - Country:US
Practice Address - Phone:213-383-4262
Practice Address - Fax:213-383-4263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3892040001332BN1400X
3336L0003X
CAPHA431773336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY55804OtherCA STATE BOARD OF PHARMACY
CACA38759OtherFURNITURE AND BEDDING RET
CACA38759OtherFURNITURE AND BEDDING RET
CA3892040001Medicare ID - Type Unspecified