Healthcare Provider Details

I. General information

NPI: 1689775108
Provider Name (Legal Business Name): BEVERLY HILLS DOCTORS SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 05/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 S SPALDING DR STE 315A
BEVERLY HILLS CA
90212-1800
US

IV. Provider business mailing address

120 S SPALDING DR SUITE 315 A
BEVERLY HILLS CA
90212-1800
US

V. Phone/Fax

Practice location:
  • Phone: 310-275-3304
  • Fax: 310-275-0418
Mailing address:
  • Phone: 310-275-3304
  • Fax: 310-275-0418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number930000935
License Number StateCA

VIII. Authorized Official

Name: MRS. CANDICE M FURLONG
Title or Position: ASC BILLER
Credential:
Phone: 626-331-6170