Provider Demographics
NPI:1437339215
Name:WESTLAKE MEDICAL SUPPLY
Entity Type:Organization
Organization Name:WESTLAKE MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, LACTATION EDUCATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:AMELIA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:RAILA
Authorized Official - Suffix:
Authorized Official - Credentials:LE
Authorized Official - Phone:818-512-6824
Mailing Address - Street 1:1228 S WESTLAKE BLVD UNIT D
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-1940
Mailing Address - Country:US
Mailing Address - Phone:818-512-6824
Mailing Address - Fax:
Practice Address - Street 1:1228 S WESTLAKE BLVD UNIT D
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-1940
Practice Address - Country:US
Practice Address - Phone:818-512-6824
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPENDING332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment