Provider Demographics
NPI:1871748962
Name:WESTFIELD MEDICAL INC
Entity type:Organization
Organization Name:WESTFIELD MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GERMAINE
Authorized Official - Middle Name:D
Authorized Official - Last Name:STROTHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-633-5236
Mailing Address - Street 1:6360 VAN NUYS BLVD
Mailing Address - Street 2:SUITE 146
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-2638
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6360 VAN NUYS BLVD
Practice Address - Street 2:SUITE 146
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-2638
Practice Address - Country:US
Practice Address - Phone:818-633-5236
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-18
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG42256207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABP514AMedicare PIN