# SANTA MONICA SPORTS MEDICINE INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205252673
- **Authorized official:** MR. JORGE MORAN M.D. (PRESIDENT)
- **Authorized official phone:** (310) 458-1259

## Contact information

- **Practice address:** 900 WILSHIRE BLVD. \#410, SANTA MONICA, CA 90401
- **Practice address phone:** (310) 458-1259
- **Practice address fax:** (310) 458-1395
- **Mailing address:** 900 WILSHIRE BLVD STE 410, SANTA MONICA, CA 90401-1886
- **Mailing address phone:** (310) 458-1259
- **Mailing address fax:** (310) 458-1395

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | A63662 | CA | Yes |

## Other

- **Enumeration date:** 03/10/2014
- **Last updated:** 03/10/2014