Provider Demographics
NPI:1417445263
Name:WEST, DUSTIN (MED, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:
Last Name:WEST
Suffix:
Gender:M
Credentials:MED, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5821 SAN AMARO DR
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-2402
Mailing Address - Country:US
Mailing Address - Phone:305-284-5056
Mailing Address - Fax:
Practice Address - Street 1:5821 SAN AMARO DR
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-2402
Practice Address - Country:US
Practice Address - Phone:305-284-5056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-27
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL36182255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer