NPIMap

Organization Active NPI

Vista West Health Center LP

Doing business as Vista West Health Center

  • Rehabilitation Chiropractor
  • Los Angeles, CA
National Provider Identifier
1972672137
Registry record updated Mar 25, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation ChiropractorTaxonomy code 111NR0400X
License
DC24645 Issued in CA
Legal business name
VISTA WEST HEALTH CENTER LP
Doing business as
Vista West Health Center
Practice address
12613 Venice Blvd.
Los Angeles, CA 90066
Phone
(310) 390-9293
Fax
(323) 820-1718
NPI assigned
Nov 6, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2016

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

Authorized official

Name
Dr. Aloysius Ifeanyi Udeze,, BSC, DC, IDE, DABDA.NPI 1235213554
Title
Director President
Phone
(310) 390-9293

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111NR0400X DC24645 CA Primary
Occupational Health ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111NX0100X DC24645 CA

Addresses

Primary practice location

12613 Venice Blvd.
Los Angeles, CA 90066

Mailing address

11012 Chanera Ave
Inglewood, CA 90303-2427
Phone (310) 390-9293

Other identifiers 2

IdentifierTypeStateIssuer
DC24645OtherCAPROVIDERS PIN#
ZZZ64099ZOtherCABLUE SHIELD OF CA GRP#

Other names 1

  • Vista West Health Center Doing business as

National Provider Directory

National Provider Directory

Locations

12324 Venice Blvd
Los Angeles, CA 90066
Phone (310) 390-9293

12613 Venice Blvd
Los Angeles, CA 90066
Phone (310) 390-9293

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458864000000",
    "number": "1972672137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11012 CHANERA AVE",
            "city": "INGLEWOOD",
            "state": "CA",
            "postal_code": "903032427",
            "telephone_number": "310-390-9293",
            "fax_number": "323-820-1718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12613 VENICE BLVD.",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90066",
            "telephone_number": "310-390-9293",
            "fax_number": "323-820-1718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VISTA WEST HEALTH CENTER LP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-06",
        "last_updated": "2016-03-25",
        "status": "A",
        "authorized_official_last_name": "UDEZE,",
        "authorized_official_first_name": "ALOYSIUS",
        "authorized_official_middle_name": "IFEANYI",
        "authorized_official_title_or_position": "DIRECTOR PRESIDENT",
        "authorized_official_telephone_number": "310-390-9293",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "BSC, DC, IDE, DABDA."
    },
    "taxonomies": [
        {
            "code": "111NR0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor, Rehabilitation",
            "state": "CA",
            "license": "DC24645",
            "primary": true
        },
        {
            "code": "111NX0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor, Occupational Health",
            "state": "CA",
            "license": "DC24645",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDERS PIN#",
            "identifier": "DC24645",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF CA GRP#",
            "identifier": "ZZZ64099Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vista West Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2016; 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.