Healthcare Provider Details

I. General information

NPI: 1083776108
Provider Name (Legal Business Name): WESTSIDE MULTISPECIALTY SURGERY CENTER, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 07/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10921 WILSHIRE BLVD #1104
LOS ANGELES CA
90024-3906
US

IV. Provider business mailing address

10921 WILSHIRE BLVD SUITE 1104
LOS ANGELES CA
90024-3906
US

V. Phone/Fax

Practice location:
  • Phone: 310-208-7744
  • Fax:
Mailing address:
  • Phone: 310-301-8329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. ISAAC VERBUKH
Title or Position: OWNER
Credential: M.D.
Phone: 310-301-8329