Provider Demographics
NPI:1962513135
Name:WESTEREN, ALAN C (MD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:C
Last Name:WESTEREN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4629 CASS ST
Mailing Address - Street 2:#59
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-2805
Mailing Address - Country:US
Mailing Address - Phone:858-673-2277
Mailing Address - Fax:858-451-3733
Practice Address - Street 1:16486 BERNARDO CENTER DR
Practice Address - Street 2:SUITE C-150
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2518
Practice Address - Country:US
Practice Address - Phone:858-673-2277
Practice Address - Fax:858-451-3733
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG79738207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG79738OtherCA STATE MEDICAL LICENSE#
CA00G797380Medicaid
CA11179547OtherCAQH PROVIDER ID#
PAMD-072371-LOtherPA STATE MEDICAL LICENSE#
CAG34554Medicare UPIN
CA11179547OtherCAQH PROVIDER ID#
CAW18008BMedicare ID - Type UnspecifiedSAN DIEGO OFFICE
CAWG79738IMedicare PIN
CA00G797380Medicaid
PAMD-072371-LOtherPA STATE MEDICAL LICENSE#
CAG79738OtherCA STATE MEDICAL LICENSE#
CAW18008Medicare ID - Type UnspecifiedCOSTA MESA OFFICE