Healthcare Provider Details

I. General information

NPI: 1730094707
Provider Name (Legal Business Name): WEST-SIDE ELECTROLYSIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2026
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 E BARISTO RD APT 4
PALM SPRINGS CA
92262-7150
US

IV. Provider business mailing address

1900 E BARISTO RD APT 4
PALM SPRINGS CA
92262-7150
US

V. Phone/Fax

Practice location:
  • Phone: 760-534-9257
  • Fax:
Mailing address:
  • Phone: 760-534-9257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225500000X
TaxonomyRespiratory/Developmental/Rehabilitative Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: CONRAD WATKINS
Title or Position: PRESIDENT
Credential: LE
Phone: 760-534-9257