Healthcare Provider Details

I. General information

NPI: 1942380787
Provider Name (Legal Business Name): ROBERTO REY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 07/21/2022
Certification Date: 02/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 N ROXBURY DR STE 400
BEVERLY HILLS CA
90210-4218
US

IV. Provider business mailing address

435 N BEDFORD DR PH
BEVERLY HILLS CA
90210-4316
US

V. Phone/Fax

Practice location:
  • Phone: 310-205-3107
  • Fax: 310-205-8855
Mailing address:
  • Phone: 310-205-3107
  • Fax: 310-205-8822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number131200
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberG076688
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: