Provider Demographics
NPI:1902444623
Name:SKILLED PHYSICIANS GROUP
Entity Type:Organization
Organization Name:SKILLED PHYSICIANS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARDIA
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:ANVAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-445-5999
Mailing Address - Street 1:12021 WILSHIRE BLVD # 745
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1206
Mailing Address - Country:US
Mailing Address - Phone:310-445-5999
Mailing Address - Fax:
Practice Address - Street 1:3747 FOOTHILL BLVD # B140
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91214-1700
Practice Address - Country:US
Practice Address - Phone:310-445-5999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-12
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty