Healthcare Provider Details

I. General information

NPI: 1104909068
Provider Name (Legal Business Name): WESTSIDE MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 03/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 WESTWOOD BLVD FL 1
LOS ANGELES CA
90024-5608
US

IV. Provider business mailing address

1700 WESTWOOD BLVD FL 1
LOS ANGELES CA
90024-5608
US

V. Phone/Fax

Practice location:
  • Phone: 310-234-6600
  • Fax: 310-234-6604
Mailing address:
  • Phone: 310-234-6600
  • Fax: 310-234-6604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberA40040
License Number StateCA

VIII. Authorized Official

Name: SOHRAB YAMINI
Title or Position: OWNER
Credential: MD
Phone: 310-234-6600