Santa Monica Sports Medicine Inc.

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

A63662 Issued in CA

Legal business name

SANTA MONICA SPORTS MEDICINE INC.

Practice address

900 Wilshire Blvd. #410
Santa Monica, CA 90401

Phone

(310) 458-1259

Fax

(310) 458-1395

NPI assigned

Mar 10, 2014

Last updated

Mar 10, 2014By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Jorge Moran, M.D.

Title

President

Phone

(310) 458-1259

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1394409600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1394409600000",
    "number": "1205252673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 WILSHIRE BLVD STE 410",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904011886",
            "telephone_number": "310-458-1259",
            "fax_number": "310-458-1395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 WILSHIRE BLVD. #410",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "90401",
            "telephone_number": "310-458-1259",
            "fax_number": "310-458-1395"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANTA MONICA SPORTS MEDICINE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-10",
        "last_updated": "2014-03-10",
        "status": "A",
        "authorized_official_last_name": "MORAN",
        "authorized_official_first_name": "JORGE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-458-1259",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "CA",
            "license": "A63662",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Santa Monica Psychology Group, Inc
• Santa Monica Psychotherapy Group
• Santa Monica Sleep Disorders Center
• Santa Monica Specialty Surgery Center
• Santa Monica Sports Medicine Center
• Santa Monica Superior Acupuncture Clinic Inc.
• Santa Monica Surgery & Laser Center Medical Associates, LLC
• Santa Monica Surgery, LLC
• Santa Monica Surgical Center
• Santa Monica Surgical Center LLC

• Physical Medicine & Rehabilitation Physician in Santa Monica, CA
• Providers in Santa Monica, CA by specialty
• Physical Medicine & Rehabilitation Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.