Provider Demographics
NPI:1851434518
Name:SKULL BASE MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:SKULL BASE MEDICAL GROUP, INC
Other - Org Name:SKULL BASE INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LARA
Authorized Official - Middle Name:KAREN
Authorized Official - Last Name:CHAHINIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-783-1989
Mailing Address - Street 1:8635 W 3RD ST
Mailing Address - Street 2:SUITE 1170W
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-6101
Mailing Address - Country:US
Mailing Address - Phone:310-691-8888
Mailing Address - Fax:310-691-8877
Practice Address - Street 1:8635 W 3RD ST
Practice Address - Street 2:SUITE 1170W
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-6101
Practice Address - Country:US
Practice Address - Phone:310-691-8888
Practice Address - Fax:310-691-8877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty