Healthcare Provider Details

I. General information

NPI: 1902444623
Provider Name (Legal Business Name): SKILLED PHYSICIANS GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2019
Last Update Date: 12/12/2019
Certification Date: 12/12/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3747 FOOTHILL BLVD # B140
GLENDALE CA
91214-1700
US

IV. Provider business mailing address

12021 WILSHIRE BLVD # 745
LOS ANGELES CA
90025-1206
US

V. Phone/Fax

Practice location:
  • Phone: 310-445-5999
  • Fax:
Mailing address:
  • Phone: 310-445-5999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: BARDIA AARON ANVAR
Title or Position: PRESIDENT
Credential: MD
Phone: 310-445-5999