Provider Demographics
NPI:1801103551
Name:BARIATRIC CENTERS OF SOUTHERN CALIFORNIA
Entity type:Organization
Organization Name:BARIATRIC CENTERS OF SOUTHERN CALIFORNIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHERIST
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:CMBC
Authorized Official - Phone:818-843-1116
Mailing Address - Street 1:822 N HOLLYWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-2831
Mailing Address - Country:US
Mailing Address - Phone:818-843-1116
Mailing Address - Fax:818-843-1119
Practice Address - Street 1:7230 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 502
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-1907
Practice Address - Country:US
Practice Address - Phone:818-843-1116
Practice Address - Fax:818-843-1119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA89045Medicare PIN
CABW715ZMedicare PIN