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General NPI Number Information
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NPI Number | 1902444623
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Entity Type | Organization
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Legal Business Name | SKILLED PHYSICIANS GROUP
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Dates
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Enumeration Date | 12/12/2019
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Last Update Date | 12/12/2019
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Provider Practice Location Address
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Address Line | 3747 FOOTHILL BLVD # B140
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City | GLENDALE
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State | CA
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Zip | 91214-1700
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Country | US
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Telephone | 310-445-5999
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Fax |
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Provider Business Mailing Address
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Address Line | 12021 WILSHIRE BLVD # 745
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City | LOS ANGELES
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State | CA
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Zip | 90025-1206
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Country | US
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Telephone | 310-445-5999
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | BARDIA AARON ANVAR
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Credential | MD
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Telephone | 310-445-5999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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