Healthcare Provider Details

I. General information

NPI: 1558502898
Provider Name (Legal Business Name): AMERI-WEST HEALTH ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2009
Last Update Date: 03/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 W LA HABRA BLVD
LA HABRA CA
90631-5404
US

IV. Provider business mailing address

202 W. LA HABRA BLVVD
LA HABRA CA
90631-5404
US

V. Phone/Fax

Practice location:
  • Phone: 562-267-7000
  • Fax: 562-267-1323
Mailing address:
  • Phone: 562-267-7000
  • Fax: 562-267-1323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA53229
License Number StateCA

VIII. Authorized Official

Name: MS. PATRICIA HALE
Title or Position: ADMINISTRATOR
Credential:
Phone: 562-267-7000