Provider Demographics
NPI:1841497013
Name:WESTRIDGE OBGYN PC
Entity type:Organization
Organization Name:WESTRIDGE OBGYN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DORA
Authorized Official - Middle Name:OLIVIA
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-247-1100
Mailing Address - Street 1:8410 W THOMAS RD BLDG 3
Mailing Address - Street 2:SUITE 134
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-3329
Mailing Address - Country:US
Mailing Address - Phone:623-247-1100
Mailing Address - Fax:623-849-9004
Practice Address - Street 1:8410 W THOMAS RD BLDG 3
Practice Address - Street 2:SUITE 134
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-3329
Practice Address - Country:US
Practice Address - Phone:623-247-1100
Practice Address - Fax:623-849-9004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20584174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ141359OtherLORENZO C. BOYCE MD
AZ154302OtherROBERT L. GALLAI
AZ154302OtherROBERT L. GALLAI
AZWMBHX01Medicare ID - Type UnspecifiedLORENZO C. BOYCE MD
AZE03496Medicare UPIN
AZF73321Medicare UPIN