1508920489 NPI number — ROBERT WEST MD INC

Table of content: (NPI 1508920489)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508920489 NPI number — ROBERT WEST MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROBERT WEST MD 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:
Provider Other Organization Name Type Code:
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:
1508920489
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 N 13TH ST STE 150
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UPLAND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91786-4905
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-985-2223
Provider Business Mailing Address Fax Number:
909-985-2233

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 N 13TH ST STE 150
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UPLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91786-4905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-985-2223
Provider Business Practice Location Address Fax Number:
909-985-2233
Provider Enumeration Date:
12/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROTAN
Authorized Official First Name:
SUE
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
909-838-7123

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  A80098 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00A80098 . This is a "HMO" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00A80098 . This is a "TRICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00A800985 . This is a "INDIVIDUAL PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00A800987 . This is a "INDIVIDUAL PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00A800988 . This is a "INDIVIDUAL PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00A80098 . This is a "PPO" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00A800980 . This is a "BLUE CROSS SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00A800986 . This is a "INDIVIDUAL PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00A80098 . This is a "COMMERCIAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00A800984 . This is a "INDIVIDUAL PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00A800983 . This is a "INDIVIDUAL PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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