Healthcare Provider Details

I. General information

NPI: 1972777910
Provider Name (Legal Business Name): SURGICAL ARTS OF BEVERLY HILLS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2008
Last Update Date: 05/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9401 WILSHIRE BLVD SUITE 1105
BEVERLY HILLS CA
90212-2928
US

IV. Provider business mailing address

9401 WILSHIRE BLVD SUITE 1105
BEVERLY HILLS CA
90212-2928
US

V. Phone/Fax

Practice location:
  • Phone: 310-858-7500
  • Fax: 310-858-2275
Mailing address:
  • Phone: 310-858-7500
  • Fax: 310-858-2275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberG86810
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberG86810
License Number StateCA

VIII. Authorized Official

Name: DR. WILLIAM A BRENNAN
Title or Position: OWNER
Credential: MD
Phone: 310-858-7500