Healthcare Provider Details

I. General information

NPI: 1295769131
Provider Name (Legal Business Name): 90210 SURGERY MEDICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 10/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 N ROXBURY DR SUITE 600
BEVERLY HILLS CA
90210-4232
US

IV. Provider business mailing address

450 N ROXBURY DR SUITE 600
BEVERLY HILLS CA
90210-4232
US

V. Phone/Fax

Practice location:
  • Phone: 310-651-2280
  • Fax: 310-651-2260
Mailing address:
  • Phone: 310-651-2280
  • Fax: 310-651-2260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: JANNA L. ESPARZA
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 951-699-0303