Basic Information
| Provider Information | |||||||||
| NPI: | 1992248918 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WEST COAST SURGERY INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 36915 COOK STREET | ||||||||
| Address2: | SUITE 103 B | ||||||||
| City: | PALM DESERT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7603401003 | ||||||||
| FaxNumber: | 7603404844 | ||||||||
| Practice Location | |||||||||
| Address1: | 36915 COOK STREET | ||||||||
| Address2: | SUITE 103 B | ||||||||
| City: | PALM DESERT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7603401003 | ||||||||
| FaxNumber: | 7603404844 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2016 | ||||||||
| LastUpdateDate: | 11/23/2016 | ||||||||
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| AuthorizedOfficialLastName: | KHAN | ||||||||
| AuthorizedOfficialFirstName: | SANA | ||||||||
| AuthorizedOfficialMiddleName: | MARIAM | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7606417217 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D.O | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XS0117X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine | 207X00000X | G85632 | CA | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.