Organization
SKYWATER HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORENA BARONI (OFFICE MANAGER)
(310) 541-7911
Entity
Organization
Contact information
Practice address
26516 CRENSHAW BLVD, PALOS VERDES PENINSULA, CA 90274-3970
(310) 541-7911
(310) 541-4256
Mailing address
26516 CRENSHAW BLVD, PALOS VERDES PENINSULA, CA 90274-3970
(310) 541-7911
(310) 541-4256
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1992734701
MEDICARE
CA
05
—
1992734701
—
CA
Enumeration date
03/28/2019
Last updated
03/28/2019
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