Basic Information
| Provider Information | |||||||||
| NPI: | 1659926327 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WESTSIDE ANESTHESIA 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 | ||||||||
| TelephoneNumber: | 3108569488 | ||||||||
| FaxNumber: | 3108176402 | ||||||||
| Practice Location | |||||||||
| Address1: | 1964 WESTWOOD BLVD STE 436 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900254695 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108569488 | ||||||||
| FaxNumber: | 3108176402 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2019 | ||||||||
| LastUpdateDate: | 08/08/2019 | ||||||||
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| AuthorizedOfficialLastName: | LALANI | ||||||||
| AuthorizedOfficialFirstName: | FAISAL | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 3108569488 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.