Healthcare Provider Details

I. General information

NPI: 1659926327
Provider Name (Legal Business Name): WESTSIDE ANESTHESIA GROUP A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2019
Last Update Date: 08/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1964 WESTWOOD BLVD STE 436
LOS ANGELES CA
90025-4695
US

IV. Provider business mailing address

1964 WESTWOOD BLVD STE 436
LOS ANGELES CA
90025-4695
US

V. Phone/Fax

Practice location:
  • Phone: 310-856-9488
  • Fax: 310-817-6402
Mailing address:
  • Phone: 310-856-9488
  • Fax: 310-817-6402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. FAISAL LALANI
Title or Position: ADMINISTRATOR
Credential: MD
Phone: 310-856-9488