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General NPI Number Information
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NPI Number | 1851565055
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Entity Type | Organization
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Legal Business Name | WEST COAST CENTER FOR ORTHOPEDIC SURGERY AND SPORTS MEDICINE
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Dates
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Enumeration Date | 04/17/2008
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Last Update Date | 04/17/2008
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Provider Practice Location Address
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Address Line | 1200 ROSECRANS AVE SUITE 208
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City | MANHATTAN BEACH
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State | CA
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Zip | 90266-2462
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Country | US
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Telephone | 310-416-9700
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Fax | 310-416-1120
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Provider Business Mailing Address
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Address Line | 1200 ROSECRANS AVE SUITE 208
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City | MANHATTAN BEACH
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State | CA
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Zip | 90266-2462
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Country | US
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Telephone | 310-416-9700
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Fax | 310-416-1120
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Authorized Official
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Title or Position | OWNER
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Name | KEITH SIMON FEDER
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Credential | M.D.
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Telephone | 310-416-9700
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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 | G63788
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License Number State | CA
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