Provider Demographics
NPI:1689189664
Name:WEST COAST DME & SUPPLIES LLC
Entity Type:Organization
Organization Name:WEST COAST DME & SUPPLIES LLC
Other - Org Name:ORTHOKINETIX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:CPED
Authorized Official - Phone:909-477-3117
Mailing Address - Street 1:1835 CHICAGO AVE STE A
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-2309
Mailing Address - Country:US
Mailing Address - Phone:909-477-3117
Mailing Address - Fax:
Practice Address - Street 1:30101 AGOURA CT STE 114
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-4301
Practice Address - Country:US
Practice Address - Phone:909-477-3117
Practice Address - Fax:909-303-9244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-12
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA77673332B00000X
CA335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies