Healthcare Provider Details

I. General information

NPI: 1922323849
Provider Name (Legal Business Name): ROXBURY BEVERLY HILLS SURGICAL MEDICAL CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2010
Last Update Date: 04/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 N ROXBURY DR SUITE 405
BEVERLY HILLS CA
90210-5027
US

IV. Provider business mailing address

435 N ROXBURY DR SUITE 405
BEVERLY HILLS CA
90210-5027
US

V. Phone/Fax

Practice location:
  • Phone: 310-275-2472
  • Fax: 310-247-9732
Mailing address:
  • Phone: 310-275-2472
  • Fax: 310-247-9732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberA54193
License Number StateCA

VIII. Authorized Official

Name: ALEXANDER SOROKURS
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 310-275-2472