Provider Demographics
NPI:1922451004
Name:WEST COAST MEDICAL, INC
Entity Type:Organization
Organization Name:WEST COAST MEDICAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:
Authorized Official - Last Name:NORDBLUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-465-8232
Mailing Address - Street 1:PO BOX 365
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91319-0365
Mailing Address - Country:US
Mailing Address - Phone:805-465-8221
Mailing Address - Fax:805-426-8564
Practice Address - Street 1:803 CAMARILLO SPRINGS RD
Practice Address - Street 2:SUITE C
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-9459
Practice Address - Country:US
Practice Address - Phone:805-465-8200
Practice Address - Fax:805-426-8564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-13
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies