Provider Demographics
NPI:1689954539
Name:SANTA MONICA SURGERY & LASER CENTER MEDICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:SANTA MONICA SURGERY & LASER CENTER MEDICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:ABERGEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-829-2005
Mailing Address - Street 1:2001 SANTA MONICA BLVD.
Mailing Address - Street 2:SUITE #1288W
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404
Mailing Address - Country:US
Mailing Address - Phone:310-829-2005
Mailing Address - Fax:310-453-9201
Practice Address - Street 1:2001 SANTA MONICA BLVD.
Practice Address - Street 2:SUITE 1288W
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404
Practice Address - Country:US
Practice Address - Phone:310-829-2005
Practice Address - Fax:310-453-9201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-24
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41084207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS051329Medicare UPIN
CA05C0001329Medicare Oscar/Certification