MEDICARE: ALAN C. WESTEREN M.D.

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	207W00000X	Ophthalmology Physician	G79738	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G79738	OTHER	CA	CA STATE MEDICAL LICENSE#
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	11179547	OTHER	CA	CAQH PROVIDER ID#
4	MD-072371-L	OTHER	PA	PA STATE MEDICAL LICENSE#

General Provider Information

NPI Number	:	1962513135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALAN C. WESTEREN M.D.

Provider Business Mailing Address
First Line	:	4629 CASS ST
Second Line	:	#59
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-2805
Country	:	US
Telephone Number	:	858-673-2277
Fax Number	:	858-451-3733

Provider Business Practice Location Address
First Line	:	16486 BERNARDO CENTER DR
Second Line	:	SUITE C-150
City	:	SAN DIEGO
State	:	CA
Zip	:	92128-2518
Country	:	US
Telephone Number	:	858-673-2277
Fax Number	:	858-451-3733

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	10/21/2009

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