Basic Information
| Provider Information | |||||||||
| NPI: | 1104018423 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SKILLED FACILITY HEALTH CARE SOLUTIONS INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12021 WILSHIRE BLVD | ||||||||
| Address2: | SUITE 745 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900251206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103481900 | ||||||||
| FaxNumber: | 3106704822 | ||||||||
| Practice Location | |||||||||
| Address1: | 211 S BEVERLY DR | ||||||||
| Address2: | |||||||||
| City: | BEVERLY HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902123807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3104455999 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2007 | ||||||||
| LastUpdateDate: | 08/17/2022 | ||||||||
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| AuthorizedOfficialLastName: | ANVAR | ||||||||
| AuthorizedOfficialFirstName: | BARDIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3104456622 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 08/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | A86336 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.