Provider Demographics
NPI:1497742688
Name:WESTSIDE MEDICAL ASSOCIATES OF LOS ANGELES
Entity Type:Organization
Organization Name:WESTSIDE MEDICAL ASSOCIATES OF LOS ANGELES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SAIED
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEMIRANEI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-623-1146
Mailing Address - Street 1:99 N LA CIENEGA BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2222
Mailing Address - Country:US
Mailing Address - Phone:310-623-1146
Mailing Address - Fax:310-623-1142
Practice Address - Street 1:99 N LA CIENEGA BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2222
Practice Address - Country:US
Practice Address - Phone:310-623-1146
Practice Address - Fax:310-623-1142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC41453174400000X
CAA48701174400000X
CAG45390174400000X
CAA37160174400000X
CAG59599174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW16393Medicare PIN