Healthcare Provider Details

I. General information

NPI: 1215307822
Provider Name (Legal Business Name): BRIGHTON SURGICAL ENDOSCOPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2015
Last Update Date: 09/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9675 BRIGHTON WAY SUITE ONE
BEVERLY HILLS CA
90210-5100
US

IV. Provider business mailing address

9675 BRIGHTON WAY SUITE ONE
BEVERLY HILLS CA
90210-5100
US

V. Phone/Fax

Practice location:
  • Phone: 310-278-3033
  • Fax:
Mailing address:
  • Phone: 310-278-3033
  • 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. NICHOLAS C KARYOTAKIS
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 310-278-3033