Provider Demographics
NPI:1831287978
Name:WESTSIDE FAMILY HEALTH CENTER
Entity Type:Organization
Organization Name:WESTSIDE FAMILY HEALTH CENTER
Other - Org Name:WESTSIDE WOMEN'S HEALTH CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:FARMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-450-4773
Mailing Address - Street 1:3861 SEPULVEDA BLVD
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-4605
Mailing Address - Country:US
Mailing Address - Phone:310-450-4773
Mailing Address - Fax:310-450-0873
Practice Address - Street 1:3861 SEPULVEDA BLVD
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-4605
Practice Address - Country:US
Practice Address - Phone:310-450-4773
Practice Address - Fax:310-450-0873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA960000185261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT11798FMedicaid
CAZZT11798FMedicaid