Healthcare Provider Details

I. General information

NPI: 1770608432
Provider Name (Legal Business Name): SANTA MONICA BAY AREA PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 02/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6029 BRISTOL PKWY STE 100
CULVER CITY CA
90230-4899
US

IV. Provider business mailing address

6029 BRISTOL PKWY STE 100
CULVER CITY CA
90230-4899
US

V. Phone/Fax

Practice location:
  • Phone: 310-417-5900
  • Fax: 310-410-1030
Mailing address:
  • Phone: 310-417-5900
  • Fax: 310-410-1030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARK NEEDHAM
Title or Position: CO-CHIEF EXECUTIVE OFFICER
Credential: MD
Phone: 310-417-5900