Provider Demographics
NPI:1588868863
Name:WEST COAST EAR NOSE AND THROAT
Entity type:Organization
Organization Name:WEST COAST EAR NOSE AND THROAT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:E
Authorized Official - Last Name:WAREHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-527-7320
Mailing Address - Street 1:2876 N. SYCAMORE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-5155
Mailing Address - Country:US
Mailing Address - Phone:805-527-7320
Mailing Address - Fax:805-527-2426
Practice Address - Street 1:2876 N. SYCAMORE
Practice Address - Street 2:SUITE 303
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-5155
Practice Address - Country:US
Practice Address - Phone:805-527-7320
Practice Address - Fax:805-527-2426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAER878AMedicare PIN