Healthcare Provider Details

I. General information

NPI: 1467747493
Provider Name (Legal Business Name): 90210 SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2011
Last Update Date: 06/17/2011
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 STE 200
BEVERLY HILLS CA
90210-4312
US

V. Phone/Fax

Practice location:
  • Phone: 310-777-0069
  • Fax:
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 CALABRIA
Title or Position: OWNER
Credential: M,D.,
Phone: 310-777-0069