Healthcare Provider Details

I. General information

NPI: 1801831490
Provider Name (Legal Business Name): SANTA MONICA BAY AREA PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 05/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 COLORADO AVE
SANTA MONICA CA
90401-2436
US

IV. Provider business mailing address

6029 BRISTOL PKWY 100
CULVER CITY CA
90230-6643
US

V. Phone/Fax

Practice location:
  • Phone: 310-260-2917
  • Fax: 310-587-9236
Mailing address:
  • Phone: 310-417-5900
  • Fax: 310-410-1001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

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