Provider Demographics
NPI:1093512360
Name:NOHO WEST MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:NOHO WEST MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:MARIBETH
Authorized Official - Middle Name:FLORESTA
Authorized Official - Last Name:MCKINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:818-745-7745
Mailing Address - Street 1:12511 OXNARD ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-4458
Mailing Address - Country:US
Mailing Address - Phone:818-745-8845
Mailing Address - Fax:818-745-8835
Practice Address - Street 1:12511 OXNARD ST UNIT A
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-4458
Practice Address - Country:US
Practice Address - Phone:818-745-8845
Practice Address - Fax:818-745-8835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care