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General NPI Number Information
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NPI Number | 1992248918
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Entity Type | Organization
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Legal Business Name | WEST COAST SURGERY INC
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Dates
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Enumeration Date | 11/22/2016
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Last Update Date | 11/23/2016
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Provider Practice Location Address
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Address Line | 36915 COOK STREET SUITE 103 B
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City | PALM DESERT
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State | CA
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Zip | 92211
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Country | US
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Telephone | 760-340-1003
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Fax | 760-340-4844
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Provider Business Mailing Address
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Address Line | 36915 COOK STREET SUITE 103 B
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City | PALM DESERT
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State | CA
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Zip | 92211
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Country | US
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Telephone | 760-340-1003
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Fax | 760-340-4844
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Authorized Official
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Title or Position | DIRECTOR
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Name | SANA MARIAM KHAN
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Credential | D.O
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Telephone | 760-641-7217
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | G85632
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License Number State | CA
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