Healthcare Provider Details

I. General information

NPI: 1881642288
Provider Name (Legal Business Name): DOHENY ENDOSURGICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 08/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9090 WILSHIRE BLVD SUITE 100
BEVERLY HILLS CA
90211-1848
US

IV. Provider business mailing address

9090 WILSHIRE BLVD SUITE 100
BEVERLY HILLS CA
90211-1848
US

V. Phone/Fax

Practice location:
  • Phone: 310-246-2555
  • Fax: 310-285-0819
Mailing address:
  • Phone: 310-246-2555
  • Fax: 310-285-0819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number69377
License Number StateCA

VIII. Authorized Official

Name: DR. JONATHAN C ELLIS
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 310-550-0400