Healthcare Provider Details

I. General information

NPI: 1003001967
Provider Name (Legal Business Name): ROXBURY CLINIC AND SURGERY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2007
Last Update Date: 06/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 N ROXBURY DR SUITE 1001
BEVERLY HILLS CA
90210-4206
US

IV. Provider business mailing address

465 N ROXBURY DR SUITE 1001
BEVERLY HILLS CA
90210-4206
US

V. Phone/Fax

Practice location:
  • Phone: 310-248-6250
  • Fax: 310-248-6258
Mailing address:
  • Phone: 310-248-6250
  • Fax: 310-248-6258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. CHONA MOORE
Title or Position: DIRECTOR OF NURSING
Credential: R.N.
Phone: 310-248-6250