Healthcare Provider Details

I. General information

NPI: 1235211137
Provider Name (Legal Business Name): 436 AESTHETIC SURGERY CENTRE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 N BEDFORD DR STE. 203
BEVERLY HILLS CA
90210-4310
US

IV. Provider business mailing address

11999 SAN VICENTE BLVD STE. 440
LOS ANGELES CA
90049-5131
US

V. Phone/Fax

Practice location:
  • Phone: 310-550-7747
  • Fax:
Mailing address:
  • Phone: 310-440-3131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. ROBERT M. APPLEBAUM
Title or Position: OWNER
Credential: M.D.
Phone: 310-440-3131