Provider Demographics
NPI:1922318062
Name:SANTA MONICA BAY PHYSICIANS
Entity Type:Organization
Organization Name:SANTA MONICA BAY PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-CEO
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:SUITE 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 1:2424 WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-5806
Practice Address - Country:US
Practice Address - Phone:310-828-4530
Practice Address - Fax:310-453-4613
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SANTA MONICA BAY PHYSICIANS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory