Provider Demographics
NPI:1083950018
Name:DAVID L. WESTRA, MD, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DAVID L. WESTRA, MD, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:WESTRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-643-2179
Mailing Address - Street 1:168 N BRENT ST
Mailing Address - Street 2:SUITE 408
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-2817
Mailing Address - Country:US
Mailing Address - Phone:805-643-2179
Mailing Address - Fax:805-643-0672
Practice Address - Street 1:168 N BRENT ST
Practice Address - Street 2:SUITE 408
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-2817
Practice Address - Country:US
Practice Address - Phone:805-643-2179
Practice Address - Fax:805-643-0672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-19
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA93870207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty