Provider Demographics
NPI:1700117546
Name:SANTA MONICA BAY AREA PHYSICIANS
Entity type:Organization
Organization Name:SANTA MONICA BAY AREA 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 2:100
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 1:2001 SANTA MONICA BLVD
Practice Address - Street 2:860
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2102
Practice Address - Country:US
Practice Address - Phone:310-828-3209
Practice Address - Fax:310-828-5165
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SANTA MONICA BAY AREA PHYSICIANS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-01-19
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG44560207RE0101X
2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14560OtherPTAN