Healthcare Provider Details

I. General information

NPI: 1750657649
Provider Name (Legal Business Name): ERIC B INGULSRUD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2012
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9401 WILSHIRE BLVD STE 515
BEVERLY HILLS CA
90212-2947
US

IV. Provider business mailing address

9401 WILSHIRE BLVD STE 515
BEVERLY HILLS CA
90212-2947
US

V. Phone/Fax

Practice location:
  • Phone: 310-657-6900
  • Fax: 310-657-6901
Mailing address:
  • Phone: 310-657-6900
  • Fax: 310-657-6901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA153670
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: