# WEST BEVERLY MEDICAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1982875860
- **Authorized official:** MR. JESSIE ANTONIO JR. (MANAGER)
- **Authorized official phone:** (323) 461-4183

## Contact information

- **Practice address:** 4643 BEVERLY BLVD, \#103, LOS ANGELES, CA 90004-3101
- **Practice address phone:** (323) 461-4183
- **Practice address fax:** (323) 461-0864
- **Mailing address:** 4643 BEVERLY BLVD, \#103, LOS ANGELES, CA 90004-3101
- **Mailing address phone:** (323) 461-4183
- **Mailing address fax:** (323) 461-0864

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/18/2008
- **Last updated:** 03/18/2008