Provider Demographics
NPI:1194197822
Name:WEST COUNTY DIAGNOSTIC ASSOCIATES, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:WEST COUNTY DIAGNOSTIC ASSOCIATES, A PROFESSIONAL CORPORATION
Other - Org Name:WEST COUNTY DIAGNOSTIC ASSOCIATES, A PROFESSIONAL CORPORATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STANTON
Authorized Official - Middle Name:S
Authorized Official - Last Name:KREMSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-210-8333
Mailing Address - Street 1:2945 TOWNSGATE ROAD
Mailing Address - Street 2:200
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-5802
Mailing Address - Country:US
Mailing Address - Phone:805-210-8333
Mailing Address - Fax:805-210-8330
Practice Address - Street 1:2945 TOWNSGATE RD
Practice Address - Street 2:200
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-5803
Practice Address - Country:US
Practice Address - Phone:805-210-8333
Practice Address - Fax:805-210-8330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-21
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty