Provider Demographics
NPI:1568499408
Name:SOUTHERN CALIFORNIA WOMENS HEALTH GROUP
Entity Type:Organization
Organization Name:SOUTHERN CALIFORNIA WOMENS HEALTH GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TAHERY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-265-9499
Mailing Address - Street 1:PO BOX 16376
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90209-2376
Mailing Address - Country:US
Mailing Address - Phone:818-265-9499
Mailing Address - Fax:818-548-0447
Practice Address - Street 1:633 N CENTRAL AVE
Practice Address - Street 2:SUITE 309
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-1801
Practice Address - Country:US
Practice Address - Phone:818-265-9499
Practice Address - Fax:818-548-0447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherTAX ID NUMBER