Healthcare Provider Details

I. General information

NPI: 1962633180
Provider Name (Legal Business Name): MARY BETH HUGHES PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2009
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 N ROBERTSON BLVD #191
BEVERLY HILLS CA
90211-1705
US

IV. Provider business mailing address

311 N ROBERTSON BLVD #191
BEVERLY HILLS CA
90211-1705
US

V. Phone/Fax

Practice location:
  • Phone: 626-337-3770
  • Fax:
Mailing address:
  • Phone: 626-337-3770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberPA20418
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA20418
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: