Healthcare Provider Details

I. General information

NPI: 1356494512
Provider Name (Legal Business Name): BEDFORD AMBULATORY SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 10/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 N BEDFORD DR STE. 215
BEVERLY HILLS CA
90210-4310
US

IV. Provider business mailing address

436 N BEDFORD DR STE 215
BEVERLY HILLS CA
90210-4310
US

V. Phone/Fax

Practice location:
  • Phone: 310-247-1932
  • Fax: 310-247-8140
Mailing address:
  • Phone: 310-247-1932
  • Fax: 310-247-8140

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 R. NIKOLOV
Title or Position: OWNER
Credential: IM.D.
Phone: 310-247-1932