Healthcare Provider Details

I. General information

NPI: 1053719773
Provider Name (Legal Business Name): BEVERLY HILLS SURGICAL & MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2014
Last Update Date: 01/24/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 WILSHIRE BLVD STE 1020
BEVERLY HILLS CA
90211-3108
US

IV. Provider business mailing address

8500 WILSHIRE BLVD STE 1020
BEVERLY HILLS CA
90211-3108
US

V. Phone/Fax

Practice location:
  • Phone: 310-360-0504
  • Fax:
Mailing address:
  • Phone: 310-360-0504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number2OA7188
License Number StateCA

VIII. Authorized Official

Name: DR. FARDAD FOROUZANPOUR
Title or Position: DIRECTOR
Credential: DO
Phone: 310-360-0504