Healthcare Provider Details

I. General information

NPI: 1720160435
Provider Name (Legal Business Name): DR. SYD PARATESTES LA VAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 N ROXBURY DR
BEVERLY HILLS CA
90210-5026
US

IV. Provider business mailing address

436 N ROXBURY DR
BEVERLY HILLS CA
90210-5026
US

V. Phone/Fax

Practice location:
  • Phone: 310-275-5318
  • Fax: 310-275-5310
Mailing address:
  • Phone: 310-275-5318
  • Fax: 310-275-5310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number30449
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: