Healthcare Provider Details

I. General information

NPI: 1922318062
Provider Name (Legal Business Name): SANTA MONICA BAY PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2010
Last Update Date: 10/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2424 WILSHIRE BLVD
SANTA MONICA CA
90403-5806
US

IV. Provider business mailing address

6029 BRISTOL PKWY SUITE 100
CULVER CITY CA
90230-6643
US

V. Phone/Fax

Practice location:
  • Phone: 310-828-4530
  • Fax: 310-453-4613
Mailing address:
  • Phone: 310-417-5900
  • Fax: 310-410-1001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: BERNARD J KATZ
Title or Position: CO-CEO
Credential: M.D.
Phone: 310-417-5900