MEDICARE: ATC MEDICAL ASSOCIATES, INC

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
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1528577020
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATC MEDICAL ASSOCIATES, INC

Provider Business Mailing Address
First Line	:	3435 OCEAN PARK BLVD STE 101
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90405-3316
Country	:	US
Telephone Number	:	310-399-0337
Fax Number	:

Provider Business Practice Location Address
First Line	:	3435 OCEAN PARK BLVD STE 101
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90405-3316
Country	:	US
Telephone Number	:	310-399-0337
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	LIOR YACCOBE
Credential	:
Telephone Number	:	310-399-0337

Provider Enumeration Date	:	09/27/2017
Last Update Date	:	07/21/2022

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