Healthcare Provider Details

I. General information

NPI: 1417711557
Provider Name (Legal Business Name): REXFORD SURGICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2024
Last Update Date: 02/08/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9301 WILSHIRE BLVD STE 401A
BEVERLY HILLS CA
90210-5424
US

IV. Provider business mailing address

9301 WILSHIRE BLVD STE 401A
BEVERLY HILLS CA
90210-5424
US

V. Phone/Fax

Practice location:
  • Phone: 310-274-3481
  • Fax: 310-274-3482
Mailing address:
  • Phone: 310-274-3481
  • Fax: 310-274-3482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SHIVA GOLSHANI
Title or Position: CONSULTANT
Credential: PHD
Phone: 310-367-6763