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General NPI Number Information
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NPI Number | 1245677491
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Entity Type | Organization
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Legal Business Name | WEST MEDICAL CENTER INC
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Dates
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Enumeration Date | 05/29/2013
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Last Update Date | 12/15/2022
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Provider Practice Location Address
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Address Line | 17609 VENTURA BLVD STE 106
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City | ENCINO
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State | CA
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Zip | 91316-3866
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Country | US
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Telephone | 818-774-2755
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Fax | 818-342-3478
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Provider Business Mailing Address
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Address Line | 18425 BURBANK BLVD STE 102
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City | TARZANA
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State | CA
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Zip | 91356-2812
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Country | US
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Telephone | 818-342-2696
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Fax | 818-342-3478
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Authorized Official
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Title or Position | PRESIDENT
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Name | HOOMAN SHABATIAN
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Credential | M.D.
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Telephone | 818-342-2696
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A103907
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A87662
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License Number State | CA
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