Provider Demographics
NPI:1619176625
Name:WESTERN RESIDENT TRAINING AND MANAGEMENT CORPORATION
Entity Type:Organization
Organization Name:WESTERN RESIDENT TRAINING AND MANAGEMENT CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:GUMM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-378-5424
Mailing Address - Street 1:22750 HAWTHORNE BLVD
Mailing Address - Street 2:SUITE #220
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-3664
Mailing Address - Country:US
Mailing Address - Phone:310-378-5424
Mailing Address - Fax:310-378-3824
Practice Address - Street 1:22750 HAWTHORNE BLVD
Practice Address - Street 2:SUITE #220
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-3664
Practice Address - Country:US
Practice Address - Phone:310-378-5424
Practice Address - Fax:310-378-3824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1983332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1083742241OtherPODIATRIST FOOT & ANKLE S