Provider Demographics
NPI:1699889923
Name:WEST COAST PEDIATRIC NEUROSURGICAL
Entity type:Organization
Organization Name:WEST COAST PEDIATRIC NEUROSURGICAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:MUHONEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-835-2741
Mailing Address - Street 1:1010 WEST LA VETA AVE
Mailing Address - Street 2:SUITE 710
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868
Mailing Address - Country:US
Mailing Address - Phone:714-835-2724
Mailing Address - Fax:714-835-2751
Practice Address - Street 1:1010 WEST LA VETA AVE
Practice Address - Street 2:SUITE 710
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868
Practice Address - Country:US
Practice Address - Phone:714-835-2724
Practice Address - Fax:714-835-2751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0090060Medicaid
CAW16349Medicare ID - Type Unspecified