Healthcare Provider Details

I. General information

NPI: 1861559544
Provider Name (Legal Business Name): SANTA MONICA GYNECOLOGICAL AND OBSTECTRICAL MEDICAL GROUP INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 04/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 20TH ST SUITE 270
SANTA MONICA CA
90404-2050
US

IV. Provider business mailing address

1301 20TH ST SUITE 270
SANTA MONICA CA
90404-2050
US

V. Phone/Fax

Practice location:
  • Phone: 310-828-8585
  • Fax: 310-453-4844
Mailing address:
  • Phone: 310-828-8585
  • Fax: 310-453-4844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. ALBERT PHILLIPS
Title or Position: MANAGING PARTNER
Credential:
Phone: 310-828-8585