Healthcare Provider Details

I. General information

NPI: 1518997733
Provider Name (Legal Business Name): BROTMAN MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 07/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3828 DELMAS TERRACE
CULVER CITY CA
90232-2713
US

IV. Provider business mailing address

3828 DELMAS TERRACE
CULVER CITY CA
90232-2713
US

V. Phone/Fax

Practice location:
  • Phone: 310-836-7000
  • Fax: 310-840-4141
Mailing address:
  • Phone: 310-836-7000
  • Fax: 310-840-4141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. VON CROCKETT
Title or Position: PRESIDENT CEO
Credential:
Phone: 310-836-7000