MEDICARE: SOUTHERN CALIFORNIA WOMENS HEALTH GROUP 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	207N00000X	Dermatology Physician
2	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1568499408
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN CALIFORNIA WOMENS HEALTH GROUP INC

Provider Business Mailing Address
First Line	:	PO BOX 16376
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90209-2376
Country	:	US
Telephone Number	:	818-265-9499
Fax Number	:	818-548-0447

Provider Business Practice Location Address
First Line	:	503 N CENTRAL AVE STE 201
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91203-1901
Country	:	US
Telephone Number	:	818-265-9499
Fax Number	:	818-548-0447

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MICHAEL TAHERY
Credential	:	M.D.
Telephone Number	:	818-265-9499

Provider Enumeration Date	:	06/27/2006
Last Update Date	:	05/26/2026

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