Provider Demographics
NPI:1750539672
Name:BEACH CITIES ORTHOPEDICS AND SPORTS MEDICINE
Entity type:Organization
Organization Name:BEACH CITIES ORTHOPEDICS AND SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-546-3461
Mailing Address - Street 1:400 S SEPULVEDA BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-6814
Mailing Address - Country:US
Mailing Address - Phone:310-546-3461
Mailing Address - Fax:310-546-6481
Practice Address - Street 1:400 S SEPULVEDA BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-6814
Practice Address - Country:US
Practice Address - Phone:310-546-3461
Practice Address - Fax:310-546-6481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-04
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1750539672OtherNPI