Healthcare Provider Details

I. General information

NPI: 1700935178
Provider Name (Legal Business Name): WESTWIND WOMENS SERVICES MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22110 ROSCOE BLVD SUITE 104
WEST HILLS CA
91304-3845
US

IV. Provider business mailing address

22110 ROSCOE BLVD SUITE 104
WEST HILLS CA
91304-3845
US

V. Phone/Fax

Practice location:
  • Phone: 818-704-6696
  • Fax: 818-704-6896
Mailing address:
  • Phone: 818-704-6696
  • Fax: 818-704-6896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberFNP 8981
License Number StateCA

VIII. Authorized Official

Name: MS. SUSAN E BURGER
Title or Position: NURSE PRACTITIONER
Credential: F.N.P
Phone: 818-704-6696