Healthcare Provider Details

I. General information

NPI: 1083068423
Provider Name (Legal Business Name): BEVERLY SURGICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2016
Last Update Date: 07/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 S BEVERLY DR
BEVERLY HILLS CA
90212-4402
US

IV. Provider business mailing address

450 S BEVERLY DR
BEVERLY HILLS CA
90212-4402
US

V. Phone/Fax

Practice location:
  • Phone: 310-550-0288
  • Fax: 310-550-1797
Mailing address:
  • Phone: 310-550-0288
  • Fax: 310-550-1797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberA84628
License Number StateCA

VIII. Authorized Official

Name: DR. DAVIS NGUYEN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-550-0288