Provider Demographics
NPI:1659483329
Name:WEST COAST INFECTIOUS DISEASES PA
Entity Type:Organization
Organization Name:WEST COAST INFECTIOUS DISEASES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MANCINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-669-6800
Mailing Address - Street 1:8607 EASTHAVEN CT STE 101
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-5217
Mailing Address - Country:US
Mailing Address - Phone:727-669-6800
Mailing Address - Fax:727-669-2540
Practice Address - Street 1:8607 EASTHAVEN CT STE 101
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34655-5217
Practice Address - Country:US
Practice Address - Phone:727-669-6800
Practice Address - Fax:727-669-2540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274992100Medicaid
FL274992100Medicaid
FL274992100Medicaid
FL6325010001Medicare NSC