Healthcare Provider Details

I. General information

NPI: 1285850792
Provider Name (Legal Business Name): LISA B CASSILETH, MD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 N BEDFORD DR STE 103
BEVERLY HILLS CA
90210-4323
US

IV. Provider business mailing address

436 N BEDFORD DR STE 103
BEVERLY HILLS CA
90210-4323
US

V. Phone/Fax

Practice location:
  • Phone: 310-278-8200
  • Fax:
Mailing address:
  • Phone: 310-278-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: LISA CASSILETH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-278-8200