Basic Information
| Provider Information | |||||||||
| NPI: | 1629627211 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WESTWWOOD PHYSICIANS GROUP, A MEDICAL CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1964 WESTWOOD BLVD STE 436 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900254695 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 1964 WESTWOOD BLVD STE 436 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900254695 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108569488 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2019 | ||||||||
| LastUpdateDate: | 09/06/2019 | ||||||||
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| AuthorizedOfficialLastName: | SAMIMI | ||||||||
| AuthorizedOfficialFirstName: | NADIV | ||||||||
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| AuthorizedOfficialTitleorPosition: | MD | ||||||||
| AuthorizedOfficialTelephone: | 3108569488 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
ID Information
| ID | Type | State | Issuer | Description | 4303873 | 01 | CA | PPO INSURANCE | OTHER |