Healthcare Provider Details

I. General information

NPI: 1407105646
Provider Name (Legal Business Name): STEPHEN PATT MD, CENTER FOR FAMILY PRACTICE AND ENTERTAINMENT MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2012
Last Update Date: 09/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 SANTA MONICA BLVD 888W
SANTA MONICA CA
90404-2102
US

IV. Provider business mailing address

2001 SANTA MONICA BLVD 888W
SANTA MONICA CA
90404-2102
US

V. Phone/Fax

Practice location:
  • Phone: 310-582-1114
  • Fax:
Mailing address:
  • Phone: 310-582-1114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberG47632A
License Number StateCA

VIII. Authorized Official

Name: DR. STEPHEN PATT
Title or Position: PRESIDENT
Credential: M.D
Phone: 310-582-1114