Provider Demographics
NPI:1659601920
Name:WILSHIREMED CENTER INC
Entity Type:Organization
Organization Name:WILSHIREMED CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:O'DOWD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:9098-102-7374
Mailing Address - Street 1:3881 W 6TH ST
Mailing Address - Street 2:STE 127
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-3937
Mailing Address - Country:US
Mailing Address - Phone:909-801-7374
Mailing Address - Fax:909-495-1647
Practice Address - Street 1:2131 ELKS DR
Practice Address - Street 2:STE 200
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-5544
Practice Address - Country:US
Practice Address - Phone:909-801-7374
Practice Address - Fax:909-495-1647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-07
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC42850207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty