MEDICARE: WESTSIDE MEDICAL ASSOCIATES OF LOS ANGELES

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	174400000X	Specialist	C41453	CA
2	174400000X	Specialist	A48701	CA
3	174400000X	Specialist	G45390	CA
4	174400000X	Specialist	G59599	CA
5	174400000X	Specialist	A37160	CA

General Provider Information

NPI Number	:	1497742688
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTSIDE MEDICAL ASSOCIATES OF LOS ANGELES

Provider Business Mailing Address
First Line	:	99 N LA CIENEGA BLVD
Second Line	:	SUITE 103
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-2222
Country	:	US
Telephone Number	:	310-623-1146
Fax Number	:	310-623-1142

Provider Business Practice Location Address
First Line	:	99 N LA CIENEGA BLVD
Second Line	:	SUITE 103
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-2222
Country	:	US
Telephone Number	:	310-623-1146
Fax Number	:	310-623-1142

Authorized Official
Title or Position	:	OPERATING MANAGER
Name	:	MR. SAIED SHEMIRANEI
Credential	:
Telephone Number	:	310-623-1146

Provider Enumeration Date	:	10/03/2005
Last Update Date	:	09/09/2008

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Directions to “WESTSIDE MEDICAL ASSOCIATES OF LOS ANGELES ” Practice Location

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