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General NPI Number Information
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NPI Number | 1023043551
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Entity Type | Organization
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Legal Business Name | PACIFIC WEST SPECIALTIES, LLC
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Dates
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Enumeration Date | 07/12/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 101 E REDLANDS BLVD STE 212
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City | REDLANDS
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State | CA
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Zip | 92373-4724
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Country | US
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Telephone | 909-335-8649
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Fax | 909-335-1994
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Provider Business Mailing Address
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Address Line | PO BOX 11525
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City | SAN BERNARDINO
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State | CA
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Zip | 92423-1525
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Country | US
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Telephone | 909-335-8649
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Fax | 909-335-1994
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Authorized Official
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Title or Position | C.F.O.
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Name | EDWARD ROTAN
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Credential |
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Telephone | 909-335-8649
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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