Healthcare Provider Details

I. General information

NPI: 1073044608
Provider Name (Legal Business Name): PLATINUM SURGICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2017
Last Update Date: 03/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 N ROXBURY DR STE 1017
BEVERLY HILLS CA
90210-4213
US

IV. Provider business mailing address

465 N ROXBURY DR STE 1017
BEVERLY HILLS CA
90210-4213
US

V. Phone/Fax

Practice location:
  • Phone: 310-993-3800
  • Fax:
Mailing address:
  • Phone: 310-993-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: DARIA ANDREYEVA
Title or Position: OFFICE MANAGER
Credential:
Phone: 310-993-3800