Healthcare Provider Details

I. General information

NPI: 1053593756
Provider Name (Legal Business Name): BRIGHTON MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2007
Last Update Date: 09/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9400 BRIGHTON WAY SUITE 401
BEVERLY HILLS CA
90210
US

IV. Provider business mailing address

9663 SANTA MONICA BLVD SUITE 644
BEVERLY HILLS CA
90210-4303
US

V. Phone/Fax

Practice location:
  • Phone: 310-276-9071
  • Fax: 310-276-9074
Mailing address:
  • Phone: 310-276-9071
  • Fax: 310-289-8205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. SHAWN NASSERI
Title or Position: CEO/PRESIDENT
Credential: M.D.
Phone: 310-729-3116