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General NPI Number Information
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NPI Number | 1326006693
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Entity Type | Organization
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Legal Business Name | WESTSIDE GYNECOLOGY A MEDICAL CORPORATION
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Dates
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Enumeration Date | 05/03/2006
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Last Update Date | 12/21/2011
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Provider Practice Location Address
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Address Line | 1304 15TH ST #310
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City | SANTA MONICA
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State | CA
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Zip | 90404
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Country | US
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Telephone | 310-899-9799
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Fax | 310-899-9789
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Provider Business Mailing Address
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Address Line | 1304 15TH ST #310
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City | SANTA MONICA
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State | CA
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Zip | 90404
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Country | US
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Telephone | 310-899-9799
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Fax | 310-899-9789
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHARLES F DUBIN
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Credential |
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Telephone | 310-899-9799
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number |
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License Number State |
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