Healthcare Provider Details

I. General information

NPI: 1366463929
Provider Name (Legal Business Name): CLIFFORD J MERLO MD A MEDICAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 N ROBERTSON BLVD SUITE 160
BEVERLY HILLS CA
90211-2142
US

IV. Provider business mailing address

150 N ROBERTSON BLVD SUITE 160
BEVERLY HILLS CA
90211-2142
US

V. Phone/Fax

Practice location:
  • Phone: 310-659-6770
  • Fax:
Mailing address:
  • Phone: 310-659-6770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0203X
TaxonomyRadiation Oncology Clinic/Center
License NumberG51280
License Number StateCA

VIII. Authorized Official

Name: DR. CLIFFORD J MERLO
Title or Position: PRESIDENT
Credential: MD
Phone: 310-659-6770