Provider Demographics
NPI:1932686748
Name:WEST RIDGE ANESTHESIA PC
Entity Type:Organization
Organization Name:WEST RIDGE ANESTHESIA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:D
Authorized Official - Last Name:BOWLES
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:323-289-2389
Mailing Address - Street 1:1158 26TH ST STE 131
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-4698
Mailing Address - Country:US
Mailing Address - Phone:323-289-2389
Mailing Address - Fax:
Practice Address - Street 1:2801 WILSHIRE BLVD STE B
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-4801
Practice Address - Country:US
Practice Address - Phone:215-805-7708
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-24
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4113367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty