Healthcare Provider Details

I. General information

NPI: 1750539672
Provider Name (Legal Business Name): BEACH CITIES ORTHOPEDICS AND SPORTS MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2008
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S SEPULVEDA BLVD SUITE 200
MANHATTAN BEACH CA
90266-6814
US

IV. Provider business mailing address

400 S SEPULVEDA BLVD SUITE 200
MANHATTAN BEACH CA
90266-6814
US

V. Phone/Fax

Practice location:
  • Phone: 310-546-3461
  • Fax: 310-546-6481
Mailing address:
  • Phone: 310-546-3461
  • Fax: 310-546-6481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BRADLEY THOMAS
Title or Position: PRESIDENT
Credential: MD
Phone: 310-546-3461