Healthcare Provider Details

I. General information

NPI: 1669493318
Provider Name (Legal Business Name): LLIABL MEDICAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 N ROBERTSON BLVD
BEVERLY HILLS CA
90211-2103
US

IV. Provider business mailing address

125 N ROBERTSON BLVD
BEVERLY HILLS CA
90211-2103
US

V. Phone/Fax

Practice location:
  • Phone: 310-289-9700
  • Fax: 310-289-9779
Mailing address:
  • Phone: 310-289-9700
  • Fax: 310-289-9779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG358260
License Number StateCA

VIII. Authorized Official

Name: DR. ERIC A. LEWIS
Title or Position: OWNER
Credential: M.D.
Phone: 310-289-9700