Healthcare Provider Details

I. General information

NPI: 1922293976
Provider Name (Legal Business Name): PALM SURGICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2007
Last Update Date: 09/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 S LA CIENEGA BLVD # 204
BEVERLY HILLS CA
90211-3302
US

IV. Provider business mailing address

250 S LA CIENEGA BLVD # 204
BEVERLY HILLS CA
90211-3302
US

V. Phone/Fax

Practice location:
  • Phone: 310-358-9300
  • Fax: 310-358-9156
Mailing address:
  • Phone: 310-358-9300
  • Fax: 310-358-9156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberA038198
License Number StateCA

VIII. Authorized Official

Name: DR. MASOUD MALEK
Title or Position: DR. MASOUD MALEK
Credential: M.D.
Phone: 310-358-9300