Healthcare Provider Details

I. General information

NPI: 1396724902
Provider Name (Legal Business Name): BERNARD SALICK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 09/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9777 WILSHIRE BLVD STE 512
BEVERLY HILLS CA
90212-1905
US

IV. Provider business mailing address

9777 WILSHIRE BLVD STE 512
BEVERLY HILLS CA
90212-1905
US

V. Phone/Fax

Practice location:
  • Phone: 310-967-3300
  • Fax: 310-967-3377
Mailing address:
  • Phone: 310-967-3300
  • Fax: 310-967-3377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberW3973
License Number StateCA

VIII. Authorized Official

Name: DR. BERNARD SALICK
Title or Position: PHYSICIAN
Credential: M.D.,
Phone: 310-276-7058