Healthcare Provider Details

I. General information

NPI: 1245326974
Provider Name (Legal Business Name): BEVERLY HILLS ADVANCED SURGERY INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 S SPALDING DR STE 100
BEVERLY HILLS CA
90212-1830
US

IV. Provider business mailing address

120 S SPALDING DR STE 100
BEVERLY HILLS CA
90212-1830
US

V. Phone/Fax

Practice location:
  • Phone: 310-274-8228
  • Fax: 310-516-9661
Mailing address:
  • Phone: 310-274-8228
  • Fax: 310-516-9661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ELENA JASSO
Title or Position: BILLING MANAGER
Credential:
Phone: 310-323-3041