Healthcare Provider Details

I. General information

NPI: 1316218621
Provider Name (Legal Business Name): NEW VISION MEDICAL GROUP INC PROFESSIONAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2012
Last Update Date: 05/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8484 WILSHIRE BLVD SUITE 200
BEVERLY HILLS CA
90211-3227
US

IV. Provider business mailing address

8484 WILSHIRE BLVD SUITE 200
BEVERLY HILLS CA
90211-3227
US

V. Phone/Fax

Practice location:
  • Phone: 310-360-7690
  • Fax: 310-360-9613
Mailing address:
  • Phone: 310-360-7690
  • Fax: 310-360-9613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RODNEY DANIEL COLLINS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-360-7690