Provider Demographics
NPI:1518182484
Name:WEST COAST BREAST CENTER-SANTA ANA
Entity Type:Organization
Organization Name:WEST COAST BREAST CENTER-SANTA ANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LASZLO
Authorized Official - Middle Name:P
Authorized Official - Last Name:KAVEGGIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-835-6055
Mailing Address - Street 1:1100-A N. TUSTIN AVENUE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705
Mailing Address - Country:US
Mailing Address - Phone:714-543-9927
Mailing Address - Fax:714-543-5883
Practice Address - Street 1:1100-A N. TUSTIN AVENUE
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705
Practice Address - Country:US
Practice Address - Phone:714-543-9927
Practice Address - Fax:714-543-5883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
190025OtherFDA FACILITY ID NUMBER
CA42713OtherDHS