Healthcare Provider Details

I. General information

NPI: 1336423201
Provider Name (Legal Business Name): OSTEOARTHRITIS CENTERS OF AMERICA-CARLSBAD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2011
Last Update Date: 10/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1281 CARLSBAD VILLAGE DR
CARLSBAD CA
92008-1950
US

IV. Provider business mailing address

1281 CARLSBAD VILLAGE DR
CARLSBAD CA
92008-1950
US

V. Phone/Fax

Practice location:
  • Phone: 801-312-0035
  • Fax: 866-496-5620
Mailing address:
  • Phone: 801-312-0035
  • Fax: 866-496-5620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number20A11023
License Number StateCA

VIII. Authorized Official

Name: DAN WESTENSKOW
Title or Position: VICE PRESDENT OPERATIONS
Credential:
Phone: 801-312-0035