Healthcare Provider Details

I. General information

NPI: 1164584926
Provider Name (Legal Business Name): LEBOVIC, SCHWIMER AND GOLDBERG MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 11/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9675 BRIGHTON WAY 240
BEVERLY HILLS CA
90210
US

IV. Provider business mailing address

9675 BRIGHTON WAY 240
BEVERLY HILLS CA
90210
US

V. Phone/Fax

Practice location:
  • Phone: 310-859-8104
  • Fax:
Mailing address:
  • Phone: 310-859-8104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. STANFORD ROBERT SCHWIMER
Title or Position: GENERAL PARTNER
Credential: M.D.
Phone: 310-859-8104