Healthcare Provider Details

I. General information

NPI: 1992717375
Provider Name (Legal Business Name): WESTERN MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 41ST AVE STE D
CAPITOLA CA
95010-2516
US

IV. Provider business mailing address

1595 SOQUEL DR STE 330
SANTA CRUZ CA
95065-1722
US

V. Phone/Fax

Practice location:
  • Phone: 831-476-3000
  • Fax: 831-476-9009
Mailing address:
  • Phone: 831-465-7778
  • Fax: 831-475-0351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. ROBERT KEET
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 831-465-7778