Organization
360 MIND
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KATHERINE L KERR (VP OF OPERATIONS)
(310) 582-7312
Entity
Organization
Contact information
Practice address
1328 22ND ST, SANTA MONICA, CA 90404-2032
(310) 582-7450
(310) 582-7495
Mailing address
PO BOX 7111, SANTA MONICA, CA 90406-7111
(310) 582-7450
(310) 582-7495
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
C53853
CA
207T00000X
Neurological Surgery Physician
Primary
G77318
CA
207Y00000X
Otolaryngology Physician
G88653
CA
Other
Enumeration date
07/01/2010
Last updated
07/01/2010
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