Healthcare Provider Details

I. General information

NPI: 1003437336
Provider Name (Legal Business Name): BEVERLY HILLS ENDOSURGICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2020
Last Update Date: 09/01/2020
Certification Date: 09/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 N ROBERTSON BLVD STE 110
BEVERLY HILLS CA
90211-2118
US

IV. Provider business mailing address

121 GRAY AVE STE 200
SANTA BARBARA CA
93101-1800
US

V. Phone/Fax

Practice location:
  • Phone: 888-282-7472
  • Fax:
Mailing address:
  • Phone: 888-282-7472
  • Fax:

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: DAVID ODELL
Title or Position: PRESIDENT OF MANAGING MEMBER
Credential:
Phone: 888-282-7472