Healthcare Provider Details

I. General information

NPI: 1003269945
Provider Name (Legal Business Name): BEVERLY HILLS HORMONE INSTITUTE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2016
Last Update Date: 07/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9744 WILSHIRE BLVD SUITE 200
BEVERLY HILLS CA
90212-1828
US

IV. Provider business mailing address

3701 EXECUTIVE CENTER DR SUITE 211
AUSTIN TX
78731-1644
US

V. Phone/Fax

Practice location:
  • Phone: 877-857-0146
  • Fax: 877-510-4839
Mailing address:
  • Phone: 512-571-2223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number20A14618
License Number StateCA

VIII. Authorized Official

Name: DR. LISA GORN
Title or Position: PRESIDENT
Credential: DO
Phone: 512-571-2223