Healthcare Provider Details

I. General information

NPI: 1992248918
Provider Name (Legal Business Name): WEST COAST SURGERY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2016
Last Update Date: 11/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36915 COOK STREET SUITE 103 B
PALM DESERT CA
92211
US

IV. Provider business mailing address

36915 COOK STREET SUITE 103 B
PALM DESERT CA
92211
US

V. Phone/Fax

Practice location:
  • Phone: 760-340-1003
  • Fax: 760-340-4844
Mailing address:
  • Phone: 760-340-1003
  • Fax: 760-340-4844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberG85632
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State

VIII. Authorized Official

Name: SANA MARIAM KHAN
Title or Position: DIRECTOR
Credential: D.O
Phone: 760-641-7217