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General NPI Number Information
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NPI Number | 1184631251
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Entity Type | Organization
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Legal Business Name | WESTSIDE INTERNAL MEDICINE
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Dates
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Enumeration Date | 08/02/2006
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Last Update Date | 11/26/2025
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Provider Practice Location Address
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Address Line | 2121 WILSHIRE BLVD # 304
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City | SANTA MONICA
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State | CA
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Zip | 90403
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Country | US
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Telephone | 310-264-0065
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Fax | 310-829-0765
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Provider Business Mailing Address
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Address Line | 2121 WILSHIRE BLVD STE 304
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City | SANTA MONICA
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State | CA
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Zip | 90403-5743
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Country | US
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Telephone | 310-264-0065
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Fax | 310-829-0765
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Authorized Official
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Title or Position | PARTNER
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Name | ERNIE PRUDENTE
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Credential | MD
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Telephone | 310-829-7762
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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