Healthcare Provider Details

I. General information

NPI: 1073962734
Provider Name (Legal Business Name): BABCOCK SWARTZ INTEGRATED HEALTH A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2016
Last Update Date: 06/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 N LA CIENEGA BLVD SUITE 107
WEST HOLLYWOOD CA
90069-2493
US

IV. Provider business mailing address

1106 N LA CIENEGA BLVD SUITE 107
WEST HOLLYWOOD CA
90069-2493
US

V. Phone/Fax

Practice location:
  • Phone: 310-659-8500
  • Fax: 310-652-6562
Mailing address:
  • Phone: 310-659-8500
  • Fax: 310-652-6562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number20A7803
License Number StateCA

VIII. Authorized Official

Name: KATRINA BABCOCK
Title or Position: OWNER
Credential: DO
Phone: 310-659-8500