Provider Demographics
NPI:1629623376
Name:WEST LA SPINE ASC LLC
Entity Type:Organization
Organization Name:WEST LA SPINE ASC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NADIV
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMIMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-856-9488
Mailing Address - Street 1:1964 WESTWOOD BLVD STE 436
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-4695
Mailing Address - Country:US
Mailing Address - Phone:310-856-9488
Mailing Address - Fax:
Practice Address - Street 1:1964 WESTWOOD BLVD STE 436
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-4695
Practice Address - Country:US
Practice Address - Phone:310-856-9488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA06141977OtherPPO INSURANCE