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NPI Code Detail

MEDICARE: SANTA MONICA ORTHOPAEDIC AND SPORTS MEDICINE GROUP

MEDICARE: SANTA MONICA ORTHOPAEDIC AND SPORTS MEDICINE GROUP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261Q00000XClinic/Center047467CA

General Provider Information

NPI Number : 1457423725
Entity Type Code : Organization
Provider Name (Legal Business Name) : SANTA MONICA ORTHOPAEDIC AND SPORTS MEDICINE GROUP
Provider Business Mailing Address
First Line : 2020 SANTA MONICA BLVD
Second Line : SUITE 400
City : SANTA MONICA
State : CA
Zip : 90404-2023
Country : US
Telephone Number : 310-829-2663
Fax Number : 310-315-5620
Provider Business Practice Location Address
First Line : 2020 SANTA MONICA BLVD
Second Line : SUITE 400
City : SANTA MONICA
State : CA
Zip : 90404-2023
Country : US
Telephone Number : 310-829-2663
Fax Number : 310-315-5620
Authorized Official
Title or Position : PRESIDENT
Name : DR. M RAMIN MODABBER
Credential : M.D.
Telephone Number : 310-829-2663
Provider Enumeration Date : 11/14/2006
Last Update Date : 04/07/2010

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Directions to “SANTA MONICA ORTHOPAEDIC AND SPORTS MEDICINE GROUP ” Practice Location

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