Provider Demographics
NPI:1528327087
Name:WEST COAST PRIMARY CARE, LLC
Entity type:Organization
Organization Name:WEST COAST PRIMARY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GIOVANNI
Authorized Official - Middle Name:
Authorized Official - Last Name:BAULA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-824-8270
Mailing Address - Street 1:8250 BRYAN DAIRY RD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33777-1353
Mailing Address - Country:US
Mailing Address - Phone:727-391-5008
Mailing Address - Fax:727-938-1481
Practice Address - Street 1:8250 BRYAN DAIRY RD
Practice Address - Street 2:SUITE 305
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33777-1353
Practice Address - Country:US
Practice Address - Phone:727-391-5008
Practice Address - Fax:727-938-1481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-03
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty