Healthcare Provider Details

I. General information

NPI: 1053699090
Provider Name (Legal Business Name): MIOM MEDICAL INC A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2011
Last Update Date: 03/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9001 WILSHIRE BLVD STE 106
BEVERLY HILLS CA
90211-1839
US

IV. Provider business mailing address

8581 SANTA MONICA BLVD # 991
WEST HOLLYWOOD CA
90069-4120
US

V. Phone/Fax

Practice location:
  • Phone: 310-230-5741
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: ELLIOT ALPERT
Title or Position: PRESIDENT
Credential:
Phone: 310-230-5741