| Organization Name: | JEFFERSON WEST MEDICAL GROUP |
| NPI Number: | 1023275542 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BARBARA DONAHUE (PRESIDENT) |
| Mailing Address: | 4212 Overland Ave Culver City |
| State: | CA US |
| Postal Code: | 902303736 |
| Phone Number: | 3102042574 |
| Fax Number: | 3102042820 |
| NPI Enumeration Date: | 05/21/2008 |
| NPI Last Update Date: | 05/21/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | A35973 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |