Healthcare Provider Details

I. General information

NPI: 1205411873
Provider Name (Legal Business Name): COVID TEST CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2021
Last Update Date: 03/15/2021
Certification Date: 03/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 N ROBERTSON BLVD STE 115
BEVERLY HILLS CA
90211-2121
US

IV. Provider business mailing address

PO BOX 67672
LOS ANGELES CA
90067-0672
US

V. Phone/Fax

Practice location:
  • Phone: 310-271-1122
  • Fax:
Mailing address:
  • Phone: 310-273-7365
  • Fax: 310-273-7366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PEYTON BEROOKIM
Title or Position: OWNER
Credential: MD
Phone: 310-271-1122