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Organization
PACIFIC COAST SPORTS MEDICINE
Active
Organization
PACIFIC COAST SPORTS MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WALTER OBRIEN (PRESIDENT)
(310) 477-7276
Entity
Organization
Contact information
Practice address
11600 WILSHIRE BLVD, SUITE 522, LOS ANGELES, CA 90025-5781
(310) 477-7276
(310) 477-5148
Mailing address
11600 WILSHIRE BLVD, SUITE 522, LOS ANGELES, CA 90025-5781
(310) 477-7276
(310) 477-5148
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
—
NULL
111N00000X
Chiropractor
—
—
207X00000X
Orthopaedic Surgery Physician
Primary
—
NULL
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
NULL
208100000X
Physical Medicine & Rehabilitation Physician
—
—
2085R0202X
Diagnostic Radiology Physician
—
NULL
2085R0202X
Diagnostic Radiology Physician
—
—
2085U0001X
Diagnostic Ultrasound Physician
—
NULL
2085U0001X
Diagnostic Ultrasound Physician
—
—
225100000X
Physical Therapist
—
NULL
225100000X
Physical Therapist
—
—
225700000X
Massage Therapist
—
NULL
225700000X
Massage Therapist
—
—
363A00000X
Physician Assistant
—
NULL
363A00000X
Physician Assistant
—
—
Other
Enumeration date
01/18/2012
Last updated
01/18/2012
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