Provider Demographics
NPI:1801831490
Name:SANTA MONICA BAY AREA PHYSICIANS
Entity Type:Organization
Organization Name:SANTA MONICA BAY AREA PHYSICIANS
Other - Org Name:AMERICAN WELLNESS IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO 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:310-417-5900
Mailing Address - Fax:310-410-1001
Practice Address - Street 1:524 COLORADO AVE
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-2436
Practice Address - Country:US
Practice Address - Phone:310-260-2917
Practice Address - Fax:310-587-9236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATD076OtherPTAN