Provider Demographics
NPI:1053736975
Name:THE WEITCHPEC GROUP
Entity type:Organization
Organization Name:THE WEITCHPEC GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:SHAFFER
Authorized Official - Last Name:FESUNOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-237-9289
Mailing Address - Street 1:9567 ARROW RTE
Mailing Address - Street 2:SUITE L
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-4550
Mailing Address - Country:US
Mailing Address - Phone:909-987-1661
Mailing Address - Fax:
Practice Address - Street 1:9567 ARROW RTE
Practice Address - Street 2:SUITE L
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-4550
Practice Address - Country:US
Practice Address - Phone:909-987-1661
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-28
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73021332B00000X
CA0000000332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies