Healthcare Provider Details

I. General information

NPI: 1457428880
Provider Name (Legal Business Name): BRIGHTON LASER & SURGERY INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9675 BRIGHTON WAY SUITE 410
BEVERLY HILLS CA
90210-5192
US

IV. Provider business mailing address

9675 BRIGHTON WAY SUITE 410
BEVERLY HILLS CA
90210-5192
US

V. Phone/Fax

Practice location:
  • Phone: 310-274-2525
  • Fax: 310-274-5530
Mailing address:
  • Phone: 310-274-2525
  • Fax: 310-274-5530

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: MICHAEL J GROTH
Title or Position: PARTNER
Credential: MD
Phone: 310-274-2525