Provider Demographics
NPI:1841465622
Name:CENTER FOR BIO-BEHAVIORAL SCIENCE MEDICAL CORPORATION
Entity type:Organization
Organization Name:CENTER FOR BIO-BEHAVIORAL SCIENCE MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:PODELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-556-1013
Mailing Address - Street 1:2080 CENTURY PARK E
Mailing Address - Street 2:308
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-2006
Mailing Address - Country:US
Mailing Address - Phone:310-556-0970
Mailing Address - Fax:310-556-1014
Practice Address - Street 1:2080 CENTURY PARK E
Practice Address - Street 2:308
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2006
Practice Address - Country:US
Practice Address - Phone:310-556-0970
Practice Address - Fax:310-556-1014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG323792084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA91441Medicare UPIN
CAWCP16330AMedicare PIN
CACP18843Medicare PIN