Healthcare Provider Details

I. General information

NPI: 1295973840
Provider Name (Legal Business Name): RENATO CALABRIA MD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2009
Last Update Date: 02/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 N. BEDFORD DR. SUITE 200
BEVERLY HILLS CA
90210
US

IV. Provider business mailing address

436 N. BEDFORD DR, SUITE 200
BEVERLY HILLS CA
90210
UM

V. Phone/Fax

Practice location:
  • Phone: 760-777-0069
  • Fax: 310-858-3150
Mailing address:
  • Phone: 310-777-0069
  • Fax: 310-858-3150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberA43041
License Number StateCA

VIII. Authorized Official

Name: DR. RENATO PIAR CALABRIA
Title or Position: OWNER
Credential: MD
Phone: 310-777-0069