Wicoro Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

950000025 Issued in CA

Legal business name

WICORO INC

Doing business as

Colonial Manor Conv Hospital

Practice address

919 N Sunset Ave
West Covina, CA 91790-1244

Phone

(626) 962-4489

Fax

(626) 337-4044

NPI assigned

Nov 9, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Juan Morales

Title

Office Manager

Phone

(909) 373-3766

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Colonial Manor Conv Hospital Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1264032000000",
    "number": "1669542205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "919 N SUNSET AVE",
            "city": "WEST COVINA",
            "state": "CA",
            "postal_code": "917901244",
            "telephone_number": "626-962-4489",
            "fax_number": "626-337-4044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "919 N SUNSET AVE",
            "city": "WEST COVINA",
            "state": "CA",
            "postal_code": "917901244",
            "telephone_number": "626-962-4489",
            "fax_number": "626-337-4044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WICORO INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-09",
        "last_updated": "2010-01-21",
        "status": "A",
        "authorized_official_last_name": "MORALES",
        "authorized_official_first_name": "JUAN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "909-373-3766"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "950000025",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZT18368I",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Colonial Manor Conv Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in West Covina, CA
• Providers in West Covina, CA by specialty
• Skilled Nursing Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.