Healthcare Provider Details

I. General information

NPI: 1235663261
Provider Name (Legal Business Name): DR. MILLICENT ROVELO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 N ROXBURY DR STE 1001
BEVERLY HILLS CA
90210-4213
US

IV. Provider business mailing address

465 N ROXBURY DR STE 1001
BEVERLY HILLS CA
90210-4213
US

V. Phone/Fax

Practice location:
  • Phone: 310-954-1355
  • Fax: 310-248-6256
Mailing address:
  • Phone: 310-954-1355
  • Fax: 310-248-6256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberA130080
License Number StateCA

VIII. Authorized Official

Name: DR. MILLICENT OVERLEY ROVELO
Title or Position: OWNER
Credential: M.D.
Phone: 310-403-0562