Healthcare Provider Details

I. General information

NPI: 1114078342
Provider Name (Legal Business Name): RODEO DRIVE PLASTIC SURGERY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 03/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 N RODEO DR
BEVERLY HILLS CA
90210-4536
US

IV. Provider business mailing address

421 N RODEO DR
BEVERLY HILLS CA
90210-4536
US

V. Phone/Fax

Practice location:
  • Phone: 310-550-6300
  • Fax: 310-550-6363
Mailing address:
  • Phone: 310-550-6300
  • Fax: 310-550-6363

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. LLOYD M. KRIEGER
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 310-550-6300