Healthcare Provider Details

I. General information

NPI: 1174703839
Provider Name (Legal Business Name): PATRICK T. BEZDEK M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2007
Last Update Date: 11/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11980 SAN VICENTE BLVD STE 904
LOS ANGELES CA
90049-6607
US

IV. Provider business mailing address

11980 SAN VICENTE BLVD STE 904
LOS ANGELES CA
90049-6607
US

V. Phone/Fax

Practice location:
  • Phone: 310-820-2995
  • Fax: 310-454-2587
Mailing address:
  • Phone: 310-820-2995
  • Fax: 310-454-2587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberG27084
License Number StateCA

VIII. Authorized Official

Name: DR. PATRICK T. BEZDEK
Title or Position: OWNER
Credential: M.D.
Phone: 310-820-2995