1346350758 NPI number — AMERIWEST MEDICAL ASSOCIATES INC

Table of content: (NPI 1346350758)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346350758 NPI number — AMERIWEST MEDICAL ASSOCIATES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMERIWEST MEDICAL ASSOCIATES INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
AMERIWEST HEALTH ASSOCIATES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346350758
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1930 WILSHIRE BLVD
Provider Second Line Business Mailing Address:
STE 1100
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90057-3605
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
213-483-2620
Provider Business Mailing Address Fax Number:
213-483-7918

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11850 FIRESTONE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORWALK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90650-2979
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-465-0139
Provider Business Practice Location Address Fax Number:
562-465-0138
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JAYASINGHE
Authorized Official First Name:
WALTER
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
562-465-0139

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  A52549 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207Q00000X , with the licence number: A31911 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207VG0400X , with the licence number: A26210 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 208000000X , with the licence number: A38978 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 363L00000X , with the licence number: NP349926 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: GR0060932 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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