Healthcare Provider Details

I. General information

NPI: 1962876888
Provider Name (Legal Business Name): BEVERLY HILLS SURGICAL ARTS CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2015
Last Update Date: 11/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9025 WILSHIRE BLVD STE 411
BEVERLY HILLS CA
90211-1828
US

IV. Provider business mailing address

9025 WILSHIRE BLVD STE 411
BEVERLY HILLS CA
90211-1828
US

V. Phone/Fax

Practice location:
  • Phone: 310-490-6145
  • Fax: 714-547-4710
Mailing address:
  • Phone: 310-490-6145
  • Fax: 714-547-4710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number75774
License Number StateCA

VIII. Authorized Official

Name: DR. TARICK K. SMAILI
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 310-490-6145