Provider Demographics
NPI:1255364998
Name:WEST COAST CARDIOLOGY MEDICAL GROUP INC.
Entity type:Organization
Organization Name:WEST COAST CARDIOLOGY MEDICAL GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-671-9802
Mailing Address - Street 1:575 E HARDY ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-4036
Mailing Address - Country:US
Mailing Address - Phone:310-671-9802
Mailing Address - Fax:310-671-5011
Practice Address - Street 1:575 E HARDY ST
Practice Address - Street 2:SUITE 104
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-4036
Practice Address - Country:US
Practice Address - Phone:310-671-9802
Practice Address - Fax:310-671-5011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33600207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0066190Medicaid
CA060020745OtherRAILROAD MEDICARE
CAA27194Medicare UPIN
CAW13591Medicare PIN