Basic Information
| Provider Information | |||||||||
| NPI: | 1912919309 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WESTERN MEDICAL ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1595 SOQUEL DR STE 330 | ||||||||
| Address2: | |||||||||
| City: | SANTA CRUZ | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950651722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8314657778 | ||||||||
| FaxNumber: | 8314750351 | ||||||||
| Practice Location | |||||||||
| Address1: | 13350 BIG BASIN WAY | ||||||||
| Address2: | |||||||||
| City: | BOULDER CREEK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950069237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8313386491 | ||||||||
| FaxNumber: | 8313382767 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | KEET | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 8314657778 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.