Healthcare Provider Details

I. General information

NPI: 1477088540
Provider Name (Legal Business Name): BEVERLY HILLS MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2017
Last Update Date: 04/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 N CAMDEN DR SUITE 101
BEVERLY HILLS CA
90210-4532
US

IV. Provider business mailing address

414 N CAMDEN DR SUITE 101
BEVERLY HILLS CA
90210-4532
US

V. Phone/Fax

Practice location:
  • Phone: 310-888-8818
  • Fax:
Mailing address:
  • Phone: 310-888-8818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number19917
License Number StateCA

VIII. Authorized Official

Name: BRIAN H NOVACK
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-888-8818