Provider Demographics
NPI:1073612982
Name:WESTSIDE PRIMARY CARE, INC.
Entity Type:Organization
Organization Name:WESTSIDE PRIMARY CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:ROMANA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-829-3385
Mailing Address - Street 1:9613 KIRKSIDE ROAD
Mailing Address - Street 2:
Mailing Address - City:LA
Mailing Address - State:CA
Mailing Address - Zip Code:90035
Mailing Address - Country:US
Mailing Address - Phone:310-838-8842
Mailing Address - Fax:
Practice Address - Street 1:2428 SANTA MONICA BLVD
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404
Practice Address - Country:US
Practice Address - Phone:310-829-3385
Practice Address - Fax:310-828-6635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78716173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty