Provider Demographics
NPI:1235199274
Name:WEST, JOHN GILBERT (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:GILBERT
Last Name:WEST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 S MAIN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3851
Mailing Address - Country:US
Mailing Address - Phone:714-541-0101
Mailing Address - Fax:714-541-0450
Practice Address - Street 1:230 S MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3851
Practice Address - Country:US
Practice Address - Phone:714-541-0101
Practice Address - Fax:714-541-0450
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA23086174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW10689Medicare PIN