Healthcare Provider Details

I. General information

NPI: 1073956595
Provider Name (Legal Business Name): OUTPATIENT SURGERY CENTER OF BEVERLY HILLS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2013
Last Update Date: 05/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 N CAMDEN DR SUITE 1170
BEVERLY HILLS CA
90210-4409
US

IV. Provider business mailing address

433 N CAMDEN DR SUITE 1170
BEVERLY HILLS CA
90210-4409
US

V. Phone/Fax

Practice location:
  • Phone: 310-275-1969
  • Fax:
Mailing address:
  • Phone: 310-275-1969
  • 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: DR. ASHKAN GHAVAMI
Title or Position: MEDICAL DIRECTOR / OWNER
Credential: M.D.
Phone: 310-275-1959