Healthcare Provider Details

I. General information

NPI: 1306384680
Provider Name (Legal Business Name): JUSTIN YOVINO MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2017
Last Update Date: 02/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 N LINDEN DR SUITE 440
BEVERLY HILLS CA
90210
US

IV. Provider business mailing address

462 N LINDEN DR SUITE 440
BEVERLY HILLS CA
90210
US

V. Phone/Fax

Practice location:
  • Phone: 310-887-9999
  • Fax: 888-434-6088
Mailing address:
  • Phone: 310-887-9999
  • Fax: 888-434-6088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberA119057
License Number StateCA

VIII. Authorized Official

Name: DR. JUSTIN YOVINO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-887-9999