Healthcare Provider Details

I. General information

NPI: 1841920683
Provider Name (Legal Business Name): ENDOSCOPY CENTER OF BEVERLY HILLS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2022
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8641 WILSHIRE BLVD STE 225
BEVERLY HILLS CA
90211-2900
US

IV. Provider business mailing address

PO BOX 67189
LOS ANGELES CA
90067-0189
US

V. Phone/Fax

Practice location:
  • Phone: 310-858-2224
  • Fax:
Mailing address:
  • Phone: 310-273-7365
  • Fax: 310-273-7366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0005X
TaxonomyAmbulatory Family Planning Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. PEDRAM ENAYATI
Title or Position: OWNER
Credential: MD
Phone: 310-858-2224