Organization
VISTA WEST HEALTH CENTER LP
Active
Organization
VISTA WEST HEALTH CENTER LP
Active
Other names
Vista West Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALOYSIUS IFEANYI UDEZE, BSC, DC, IDE, DABDA. (DIRECTOR PRESIDENT)
(310) 390-9293
Entity
Organization
Contact information
Practice address
12613 VENICE BLVD., LOS ANGELES, CA 90066
(310) 390-9293
(323) 820-1718
Mailing address
11012 CHANERA AVE, INGLEWOOD, CA 90303-2427
(310) 390-9293
(323) 820-1718
Taxonomy
Speciality
Code
Description
License number
State
111NR0400X
Rehabilitation Chiropractor
Primary
DC24645
CA
111NX0100X
Occupational Health Chiropractor
DC24645
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DC24645
PROVIDERS PIN#
CA
01
—
ZZZ64099Z
BLUE SHIELD OF CA GRP#
CA
Enumeration date
11/06/2006
Last updated
03/25/2016
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