Basic Information
| Provider Information | |||||||||
| NPI: | 1649458217 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WESTERN MEDICAL GROUP, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21081 S WESTERN AVE | ||||||||
| Address2: | STE 150 | ||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 905011707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3107823333 | ||||||||
| FaxNumber: | 3102126230 | ||||||||
| Practice Location | |||||||||
| Address1: | 21081 S WESTERN AVE | ||||||||
| Address2: | STE 150 | ||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 905011707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3107823333 | ||||||||
| FaxNumber: | 3102126230 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2008 | ||||||||
| LastUpdateDate: | 01/13/2014 | ||||||||
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| AuthorizedOfficialLastName: | BARLOW | ||||||||
| AuthorizedOfficialFirstName: | GARY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3107823336 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | PA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
No ID Information.