Organization
WESTSIDE GYNECOLOGY A MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES F DUBIN (PRESIDENT)
(310) 899-9799
Entity
Organization
Contact information
Practice address
1304 15TH ST, #310, SANTA MONICA, CA 90404
(310) 899-9799
(310) 899-9789
Mailing address
1304 15TH ST, #310, SANTA MONICA, CA 90404
(310) 899-9799
(310) 899-9789
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ547172
BLUE SHIELD
CA
Enumeration date
05/03/2006
Last updated
12/21/2011
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