Healthcare Provider Details

I. General information

NPI: 1730863804
Provider Name (Legal Business Name): SOUTHERN CALIFORNIA MULTI-SPECIALTY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2023
Last Update Date: 06/15/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18345 VENTURA BLVD STE 510
TARZANA CA
91356-4245
US

IV. Provider business mailing address

PO BOX 5989
ORANGE CA
92863-5989
US

V. Phone/Fax

Practice location:
  • Phone: 818-900-6488
  • Fax:
Mailing address:
  • Phone: 747-276-3049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: BABAK EGHBALIEH
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 818-900-6480