MEDICARE: SANTA MONICA BAY AREA PHYSICIANS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	W14560D	OTHER	CA	MEDICARE LOCATION PTAN

General Provider Information

NPI Number	:	1730121500
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANTA MONICA BAY AREA PHYSICIANS

Provider Business Mailing Address
First Line	:	6029 BRISTOL PKWY
Second Line	:	100
City	:	CULVER CITY
State	:	CA
Zip	:	90230-6643
Country	:	US
Telephone Number	:	310-417-5901
Fax Number	:	310-410-1001

Provider Business Practice Location Address
First Line	:	881 ALMA REAL DR
Second Line	:	214
City	:	PACIFIC PALISADES
State	:	CA
Zip	:	90272-3731
Country	:	US
Telephone Number	:	310-459-2363
Fax Number	:	310-459-1563

Authorized Official
Title or Position	:	CO CHIEF EXECUTIVE OFFICER
Name	:	DR. BERNARD J KATZ
Credential	:	MD
Telephone Number	:	310-417-5900

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	05/29/2008

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Directions to “SANTA MONICA BAY AREA PHYSICIANS ” Practice Location

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