Healthcare Provider Details

I. General information

NPI: 1063759967
Provider Name (Legal Business Name): CENTER FOR GI WEIGHT LOSS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2013
Last Update Date: 01/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9730 WILSHIRE BLVD SUITE 115
BEVERLY HILLS CA
90212-2022
US

IV. Provider business mailing address

9730 WILSHIRE BLVD SUITE 115
BEVERLY HILLS CA
90212-2022
US

V. Phone/Fax

Practice location:
  • Phone: 310-657-4444
  • Fax:
Mailing address:
  • Phone: 310-657-4444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA85911
License Number StateCA

VIII. Authorized Official

Name: ARASH NOWAIN
Title or Position: PRESIDENT
Credential: MD
Phone: 310-657-4444