| Center For Bio-behavioral Science Medical Corporation | |
|
2080 Century Park E 308 Los Angeles CA 90067-2006 | |
| (310) 556-0970 | |
| (310) 556-1014 |
| Full Name | Center For Bio-behavioral Science Medical Corporation |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 2080 Century Park E, Los Angeles, California |
| Authorized Official Name and Position | Ronald Mark Podell (CEO/OWNER) |
| Authorized Official Contact | 3105561013 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Center For Bio-behavioral Science Medical Corporation 2080 Century Park E 308 Los Angeles CA 90067-2006 Ph: (310) 556-0970 | Center For Bio-behavioral Science Medical Corporation 2080 Century Park E 308 Los Angeles CA 90067-2006 Ph: (310) 556-0970 |
| NPI Number | 1841465622 |
|---|---|
| Provider Enumeration Date | 04/23/2008 |
| Last Update Date | 04/24/2008 |
| Medicare PECOS PAC ID | 1153494232 |
|---|---|
| Medicare Enrollment ID | O20080723000172 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841465622 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0805X | Psychiatry & Neurology - Geriatric Psychiatry | G32379 (California) | Primary |
| Provider Name | James Alexander Fortman |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1306256029 PECOS PAC ID: 0749408326 Enrollment ID: I20140822001484 |
| Provider Name | Timothy Kenji Wong |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1043588775 PECOS PAC ID: 7214226190 Enrollment ID: I20160516002417 |
| Provider Name | Chin He Bae |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1841718095 PECOS PAC ID: 2860808706 Enrollment ID: I20210301002670 |
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