Provider Demographics
NPI:1730124462
Name:SANTA MONICA BAY AREA PHYSICIANS
Entity Type:Organization
Organization Name:SANTA MONICA BAY AREA PHYSICIANS
Other - Org Name:PLAZA MARINA WALK0IN URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:KATZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-417-5900
Mailing Address - Street 1:6029 BRISTOL PKWY
Mailing Address - Street 2:100
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-6643
Mailing Address - Country:US
Mailing Address - Phone:310-417-5901
Mailing Address - Fax:310-410-1001
Practice Address - Street 1:4560 ADMIRALTY WAY
Practice Address - Street 2:100
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-5423
Practice Address - Country:US
Practice Address - Phone:310-827-3700
Practice Address - Fax:310-578-5379
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SANTA MONICA BAY AREA PHYSICIANS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-17
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W14560FOtherMEDICARE LOCATION PTAN NUMBER