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Organization
WEST COVINA MEDICAL CLINIC
Active
Organization
WEST COVINA MEDICAL CLINIC
Active
Other names
West Covina Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
KERRY WEINER M.D. (PRESIDENT)
(818) 637-2000
Entity
Organization
Contact information
Practice address
1500 W WEST COVINA PKWY, WEST COVINA, CA 91790-2707
(626) 960-8614
(626) 960-9177
Mailing address
777 FLOWER ST STE A, GLENDALE, CA 91201-3000
(818) 637-2000
(818) 242-8761
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
207VG0400X
Gynecology Physician
—
—
208000000X
Pediatrics Physician
—
—
208600000X
Surgery Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1101890001
MEDICARE SUPPLIER
CA
05
—
GR0105950
—
CA
Enumeration date
02/20/2007
Last updated
02/21/2008
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