Healthcare Provider Details

I. General information

NPI: 1336383595
Provider Name (Legal Business Name): CENTRALMED INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2009
Last Update Date: 04/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11712 MOORPARK ST SUITE 211
STUDIO CITY CA
91604-2154
US

IV. Provider business mailing address

3940 LAUREL CANYON BLVD STE 177
STUDIO CITY CA
91604-3709
US

V. Phone/Fax

Practice location:
  • Phone: 818-476-2007
  • Fax:
Mailing address:
  • Phone: 818-476-2007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA62850
License Number StateCA

VIII. Authorized Official

Name: DAVID Y BADAWI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 818-476-2007