Provider Demographics
NPI:1316431273
Name:JUSTIN E. WEST, MD INC.
Entity type:Organization
Organization Name:JUSTIN E. WEST, MD INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:E
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-978-2998
Mailing Address - Street 1:230 S MAIN ST STE 210
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3851
Mailing Address - Country:US
Mailing Address - Phone:714-978-2445
Mailing Address - Fax:714-978-2998
Practice Address - Street 1:230 S MAIN ST STE 210
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3851
Practice Address - Country:US
Practice Address - Phone:714-978-2445
Practice Address - Fax:714-978-2998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-14
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1026882086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA102688OtherMEDICAL LICENSE