Provider Demographics
NPI:1346374014
Name:WESTLAKE SURGICAL CENTER
Entity Type:Organization
Organization Name:WESTLAKE SURGICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:NIKCHEVICH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-495-7416
Mailing Address - Street 1:911 HAMPSHIRE RD.
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361
Mailing Address - Country:US
Mailing Address - Phone:805-370-5522
Mailing Address - Fax:805-370-5523
Practice Address - Street 1:911 HAMPSHIRE RD.
Practice Address - Street 2:SUITE 2
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-2818
Practice Address - Country:US
Practice Address - Phone:805-370-5522
Practice Address - Fax:805-370-5523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550000254261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical