Provider Demographics
NPI:1407326606
Name:SOUTHERN CALIFORNIA MULTI-SPECIALTY CENTER INC
Entity Type:Organization
Organization Name:SOUTHERN CALIFORNIA MULTI-SPECIALTY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BABAK
Authorized Official - Middle Name:
Authorized Official - Last Name:EGHBALIEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-900-6480
Mailing Address - Street 1:5805 SEPULVEDA BLVD STE 690
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-2522
Mailing Address - Country:US
Mailing Address - Phone:818-900-6480
Mailing Address - Fax:818-900-6488
Practice Address - Street 1:5805 SEPULVEDA BLVD STE 690
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91411-2522
Practice Address - Country:US
Practice Address - Phone:818-900-6480
Practice Address - Fax:818-900-6488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-29
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty