Healthcare Provider Details

I. General information

NPI: 1114157088
Provider Name (Legal Business Name): BEVERLY HILLS INSTITUTE OF AESTHETIC AND RECONSTRUCTIVE SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2009
Last Update Date: 07/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 N BEDFORD DR SUITE 200
BEVERLY HILLS CA
90210-4322
US

IV. Provider business mailing address

416 N BEDFORD DR SUITE 200
BEVERLY HILLS CA
90210-4322
US

V. Phone/Fax

Practice location:
  • Phone: 310-278-8823
  • Fax: 310-278-2671
Mailing address:
  • Phone: 310-278-8823
  • Fax: 310-278-2671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberA 217582
License Number StateCA

VIII. Authorized Official

Name: DR. RICHARD W. FLEMING
Title or Position: PARTNER
Credential: M.D.
Phone: 310-278-8823