Healthcare Provider Details

I. General information

NPI: 1710057245
Provider Name (Legal Business Name): EAST-WEST EYE INSTITUTE A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 E 3RD ST SUITE 603
LOS ANGELES CA
90013-1644
US

IV. Provider business mailing address

420 E 3RD ST SUITE 603
LOS ANGELES CA
90013-1644
US

V. Phone/Fax

Practice location:
  • Phone: 213-680-1551
  • Fax: 213-680-2148
Mailing address:
  • Phone: 213-680-1551
  • Fax: 213-680-2148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberG49917
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberG50632
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA86442
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: RUFINA T ARGUELLO
Title or Position: BILLLING SUPERVISOR
Credential:
Phone: 213-625-2694