Provider Demographics
NPI:1659679512
Name:SA MEDICAL PHYSICIANS OF CA PC
Entity Type:Organization
Organization Name:SA MEDICAL PHYSICIANS OF CA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:ENAYATI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-551-1711
Mailing Address - Street 1:145 US HIGHWAY 46
Mailing Address - Street 2:SUITE 304
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-6830
Mailing Address - Country:US
Mailing Address - Phone:973-894-1263
Mailing Address - Fax:888-972-3703
Practice Address - Street 1:2080 CENTURY PARK E
Practice Address - Street 2:SUITE 1806
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2001
Practice Address - Country:US
Practice Address - Phone:310-551-1711
Practice Address - Fax:310-551-1311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-02
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFT721AMedicare PIN