Organization
SPORT CENTRAL OSTEOPATHIC, A MEDICAL CORPORATION
Active
Other names
Sport-Central Healthcare
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL M ROBINSON MD (DIRECTOR)
(818) 955-5112
Entity
Organization
Contact information
Practice address
8879 LAUREL CANYON BLVD, SUITE C, SUN VALLEY, CA 91352-2959
(818) 252-2000
(818) 252-6896
Mailing address
14069 MARQUESAS WAY, SUITE 216D, MARINA DEL REY, CA 90292-6052
(310) 301-3031
(310) 301-3001
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
G72600
CA
208D00000X
General Practice Physician
G72600
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G726000
BLUE CROSS BLUE SHIELD
CA
Enumeration date
11/03/2009
Last updated
03/27/2010
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