Healthcare Provider Details

I. General information

NPI: 1124301973
Provider Name (Legal Business Name): BEVERLY HILLS PAIN INSTITUTE & NEUROLOGY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2011
Last Update Date: 09/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 N CRESCENT DR STE 220
BEVERLY HILLS CA
90210-6810
US

IV. Provider business mailing address

PO BOX 12843
MARINA DEL REY CA
90295-3843
US

V. Phone/Fax

Practice location:
  • Phone: 310-888-2877
  • Fax: 310-205-9258
Mailing address:
  • Phone: 310-888-2877
  • Fax: 310-205-9258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberNP12236
License Number StateCA

VIII. Authorized Official

Name: GLADYS HAPPER
Title or Position: OWNER
Credential: NPA
Phone: 310-888-2877