Healthcare Provider Details

I. General information

NPI: 1154819126
Provider Name (Legal Business Name): WESTERN INSTITUTE OF CRITICAL CARE MEDICINE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2018
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 S MAIN ST
CORONA CA
92882-3420
US

IV. Provider business mailing address

92 ASHDALE
IRVINE CA
92620-7311
US

V. Phone/Fax

Practice location:
  • Phone: 951-737-4343
  • Fax:
Mailing address:
  • Phone: 804-306-9494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. RAMIN AKHAVAN
Title or Position: PRESIDENT
Credential: MD
Phone: 804-306-9494