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NPI Code Detail

MEDICARE: DERMATOLOGY ASSOCIATES OF WESTLAKE

MEDICARE: DERMATOLOGY ASSOCIATES OF WESTLAKE
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
1174400000XSpecialistCA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11265401251OTHERCANPI

General Provider Information

NPI Number : 1265401251
Entity Type Code : Organization
Provider Name (Legal Business Name) : DERMATOLOGY ASSOCIATES OF WESTLAKE
Provider Business Mailing Address
First Line : 1240 S WESTLAKE BLVD
Second Line : SUITE 205
City : WESTLAKE VILLAGE
State : CA
Zip : 91361-1929
Country : US
Telephone Number : 805-495-0551
Fax Number : 805-496-8079
Provider Business Practice Location Address
First Line : 1240 S WESTLAKE BLVD
Second Line : SUITE 205
City : WESTLAKE VILLAGE
State : CA
Zip : 91361-1929
Country : US
Telephone Number : 805-495-0551
Fax Number : 805-496-8079
Authorized Official
Title or Position : PARTNER
Name : DR. RANDOLPH CAPRI
Credential : MD
Telephone Number : 805-495-0551
Provider Enumeration Date : 03/14/2006
Last Update Date : 09/07/2010

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1053371096 — MICHAEL ROBERT BASTIEN MD
Practice Location Address:
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Practice Fax: 805-496-8079

Directions to “DERMATOLOGY ASSOCIATES OF WESTLAKE ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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