Healthcare Provider Details

I. General information

NPI: 1821590969
Provider Name (Legal Business Name): SURGICAL INSTITUTE OF BEVERLY HILLS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2018
Last Update Date: 03/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8920 WILSHIRE BLVD STE 611B
BEVERLY HILLS CA
90211-2006
US

IV. Provider business mailing address

PO BOX 5203
BEVERLY HILLS CA
90209-5203
US

V. Phone/Fax

Practice location:
  • Phone: 310-854-1174
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: JAMSHID NAZARIAN
Title or Position: MEDICAL RECORDS
Credential:
Phone: 310-914-9150