Healthcare Provider Details

I. General information

NPI: 1467623827
Provider Name (Legal Business Name): CPC SANTA MONICA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2008
Last Update Date: 07/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 SANTA MONICA BLVD
SANTA MONICA CA
90404-2023
US

IV. Provider business mailing address

2020 SANTA MONICA BLVD
SANTA MONICA CA
90404-2023
US

V. Phone/Fax

Practice location:
  • Phone: 310-573-8866
  • Fax:
Mailing address:
  • Phone: 310-573-8866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. JILL MAYER
Title or Position: BILLER
Credential:
Phone: 480-626-4589