Healthcare Provider Details

I. General information

NPI: 1861617896
Provider Name (Legal Business Name): WOMENS MEDICAL GROUP OF SANTA MONICA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 12/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 BROADWAY
SANTA MONICA CA
90404-2711
US

IV. Provider business mailing address

1441 BROADWAY
SANTA MONICA CA
90404-2711
US

V. Phone/Fax

Practice location:
  • Phone: 310-264-1777
  • Fax: 310-264-1787
Mailing address:
  • Phone: 310-264-1777
  • Fax: 310-264-1787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VH0002X
TaxonomyHospice and Palliative Medicine (Obstetrics & Gynecology) Physician
License Number
License Number State

VIII. Authorized Official

Name: ALLISON M LEONG
Title or Position: PARTNER
Credential: M.D.
Phone: 310-264-1777