Provider Demographics
NPI:1861888331
Name:WEST COAST MEDICAL CARE PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:WEST COAST MEDICAL CARE PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEKSANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:USOROV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-677-0008
Mailing Address - Street 1:5350 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95841-3169
Mailing Address - Country:US
Mailing Address - Phone:916-677-0008
Mailing Address - Fax:916-515-9994
Practice Address - Street 1:5350 MADISON AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95841-3169
Practice Address - Country:US
Practice Address - Phone:916-677-0008
Practice Address - Fax:916-515-9994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-12
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA93634207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA93634OtherCALIFORNIA MEDICAL BOARD