Provider Demographics
NPI:1326584277
Name:HEALTH ATLAST WEST LA
Entity Type:Organization
Organization Name:HEALTH ATLAST WEST LA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:HIGASHI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:310-390-9018
Mailing Address - Street 1:2428 SANTA MONICA BLVD STE 308
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2046
Mailing Address - Country:US
Mailing Address - Phone:310-453-8393
Mailing Address - Fax:310-453-8696
Practice Address - Street 1:2428 SANTA MONICA BLVD STE 308
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2046
Practice Address - Country:US
Practice Address - Phone:310-453-8393
Practice Address - Fax:310-453-8696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-17
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty