MEDICARE: HEALTH WEST MEDICAL CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	G41041	CA

General Provider Information

NPI Number	:	1093875767
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTH WEST MEDICAL CENTER, INC.

Provider Business Mailing Address
First Line	:	5632 VAN NUYS BLVD
Second Line	:	#113
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91401-4602
Country	:	US
Telephone Number	:	818-786-3318
Fax Number	:

Provider Business Practice Location Address
First Line	:	14417 BURBANK BLVD
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91401-4824
Country	:	US
Telephone Number	:	818-786-3318
Fax Number	:

Authorized Official
Title or Position	:	SECRETARY
Name	:	ALAN H SEPLOW
Credential	:
Telephone Number	:	818-786-3318

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	08/22/2020

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