MEDICARE: WEST SURGERY CENTER

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	261QA1903X	Ambulatory Surgical Clinic/Center		CA

General Provider Information

NPI Number	:	1699218313
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST SURGERY CENTER

Provider Business Mailing Address
First Line	:	11645 WILSHIRE BLVD STE 987
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-6814
Country	:	US
Telephone Number	:	310-393-9359
Fax Number	:

Provider Business Practice Location Address
First Line	:	11645 WILSHIRE BLVD STE 987
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-6814
Country	:	US
Telephone Number	:	310-393-9359
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DAVID GHOZLAND
Credential	:	M.D.
Telephone Number	:	310-393-9359

Provider Enumeration Date	:	11/29/2016
Last Update Date	:	11/29/2016

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Directions to “WEST SURGERY CENTER ” Practice Location

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