Provider Demographics
NPI:1689320939
Name:WEST COAST DIAGNOSTIC SERVICES
Entity Type:Organization
Organization Name:WEST COAST DIAGNOSTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:O
Authorized Official - Last Name:HEISSER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:562-972-4945
Mailing Address - Street 1:222 W 6TH ST STE 400
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-3345
Mailing Address - Country:US
Mailing Address - Phone:800-851-2607
Mailing Address - Fax:
Practice Address - Street 1:222 W 6TH ST STE 400
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-3345
Practice Address - Country:US
Practice Address - Phone:800-851-2607
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-25
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory