Basic Information
| Provider Information | |||||||||
| NPI: | 1922318062 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SANTA MONICA BAY PHYSICIANS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6029 BRISTOL PKWY | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | CULVER CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902306643 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3104175900 | ||||||||
| FaxNumber: | 3104101001 | ||||||||
| Practice Location | |||||||||
| Address1: | 2424 WILSHIRE BLVD | ||||||||
| Address2: | |||||||||
| City: | SANTA MONICA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 904035806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108284530 | ||||||||
| FaxNumber: | 3104534613 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2010 | ||||||||
| LastUpdateDate: | 10/07/2010 | ||||||||
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| AuthorizedOfficialLastName: | KATZ | ||||||||
| AuthorizedOfficialFirstName: | BERNARD | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | CO-CEO | ||||||||
| AuthorizedOfficialTelephone: | 3104175900 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SANTA MONICA BAY PHYSICIANS | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.