Healthcare Provider Details

I. General information

NPI: 1730124462
Provider Name (Legal Business Name): SANTA MONICA BAY AREA PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4560 ADMIRALTY WAY 100
MARINA DEL REY CA
90292-5423
US

IV. Provider business mailing address

6029 BRISTOL PKWY 100
CULVER CITY CA
90230-6643
US

V. Phone/Fax

Practice location:
  • Phone: 310-827-3700
  • Fax: 310-578-5379
Mailing address:
  • Phone: 310-417-5901
  • Fax: 310-410-1001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BERNARD J KATZ
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MD
Phone: 310-417-5900