Provider Demographics
NPI:1508920489
Name:ROBERT WEST MD INC
Entity Type:Organization
Organization Name:ROBERT WEST MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-838-7123
Mailing Address - Street 1:600 N 13TH ST STE 150
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4905
Mailing Address - Country:US
Mailing Address - Phone:909-985-2223
Mailing Address - Fax:909-985-2233
Practice Address - Street 1:600 N 13TH ST STE 150
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4905
Practice Address - Country:US
Practice Address - Phone:909-985-2223
Practice Address - Fax:909-985-2233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA80098207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A80098OtherHMO
CA00A80098OtherTRICARE
CA00A800985OtherINDIVIDUAL PTAN
CA00A800987OtherINDIVIDUAL PTAN
CA00A800988OtherINDIVIDUAL PTAN
CA00A80098OtherPPO
CA00A800980OtherBLUE CROSS SHIELD
CA00A800986OtherINDIVIDUAL PTAN
CA00A80098OtherCOMMERCIAL
CA00A800984OtherINDIVIDUAL PTAN
CA00A800983OtherINDIVIDUAL PTAN
CA00A80098OtherCOMMERCIAL
CA00A800986OtherINDIVIDUAL PTAN