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General NPI Number Information
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NPI Number | 1346374014
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Entity Type | Organization
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Legal Business Name | WESTLAKE SURGICAL CENTER
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 04/25/2017
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Provider Practice Location Address
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Address Line | 911 HAMPSHIRE RD. SUITE 2
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City | WESTLAKE VILLAGE
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State | CA
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Zip | 91361-2818
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Country | US
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Telephone | 805-370-5522
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Fax | 805-370-5523
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Provider Business Mailing Address
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Address Line | 911 HAMPSHIRE RD. SUITE 2
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City | WESTLAKE VILLAGE
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State | CA
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Zip | 91361
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Country | US
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Telephone | 805-370-5522
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Fax | 805-370-5523
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Authorized Official
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Title or Position | CEO
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Name | DR. DONALD NIKCHEVICH
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Credential | DDS
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Telephone | 805-495-7416
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 550000254
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License Number State | CA
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