Healthcare Provider Details

I. General information

NPI: 1982158663
Provider Name (Legal Business Name): BEVERLY HILLS MIGRAINE AND PAIN MANAGEMENT INSTITUTE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2016
Last Update Date: 04/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 N ROXBURY DR STE 115
BEVERLY HILLS CA
90210-5016
US

IV. Provider business mailing address

436 N ROXBURY DR STE 115
BEVERLY HILLS CA
90210-5016
US

V. Phone/Fax

Practice location:
  • Phone: 424-302-0289
  • Fax:
Mailing address:
  • Phone: 424-302-0289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BENJAMIN TAIMOORAZY
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 424-302-0289