Healthcare Provider Details

I. General information

NPI: 1518524875
Provider Name (Legal Business Name): BEVERLY HILLS SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2019
Last Update Date: 07/22/2020
Certification Date: 07/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 WILSHIRE BLVD STE 630
BEVERLY HILLS CA
90211-3139
US

IV. Provider business mailing address

18080 BEACH BLVD STE 101
HUNTINGTON BEACH CA
92648-1343
US

V. Phone/Fax

Practice location:
  • Phone: 310-657-7741
  • Fax:
Mailing address:
  • Phone: 714-848-5555
  • Fax: 888-977-3286

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: CRYSTAL MARIN
Title or Position: ADMINISTRATOR
Credential:
Phone: 714-848-5555