Provider Demographics
NPI:1811125198
Name:WEST COAST MEDICAL ASSOCIATES, LLC
Entity type:Organization
Organization Name:WEST COAST MEDICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:KOVINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:424-335-0520
Mailing Address - Street 1:8777 W PICO BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-2212
Mailing Address - Country:US
Mailing Address - Phone:424-335-0520
Mailing Address - Fax:424-335-0521
Practice Address - Street 1:8777 W PICO BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-2212
Practice Address - Country:US
Practice Address - Phone:424-335-0520
Practice Address - Fax:424-335-0521
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YMA ACQUISITION, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-25
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY538393336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1811125198Medicaid
CA1811125198Medicaid