Healthcare Provider Details

I. General information

NPI: 1902533037
Provider Name (Legal Business Name): BEVERLY HILLS RECONSTRUCTIVE SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2022
Last Update Date: 08/08/2022
Certification Date: 08/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 N ROXBURY DR STE 315
BEVERLY HILLS CA
90210-5027
US

IV. Provider business mailing address

435 N ROXBURY DR STE 315
BEVERLY HILLS CA
90210-5027
US

V. Phone/Fax

Practice location:
  • Phone: 310-620-8750
  • Fax: 310-620-8751
Mailing address:
  • Phone: 310-620-8750
  • Fax: 310-620-8751

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. JAMIE C ZAMPELL
Title or Position: PRESIDENT
Credential: MD
Phone: 310-620-8750