Provider Demographics
NPI:1972510451
Name:WEST, PHILLIP N (MD)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:N
Last Name:WEST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2415 BATH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-4324
Mailing Address - Country:US
Mailing Address - Phone:805-687-3744
Mailing Address - Fax:805-687-6048
Practice Address - Street 1:2415 BATH ST
Practice Address - Street 2:SUITE A
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-4324
Practice Address - Country:US
Practice Address - Phone:805-687-3744
Practice Address - Fax:805-687-6048
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG44660174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE05307Medicare UPIN