Healthcare Provider Details

I. General information

NPI: 1285937763
Provider Name (Legal Business Name): BEVERLY HILLS PLASTIC SURGERY MANAGEMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2010
Last Update Date: 03/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E 28TH ST STE 301
LONG BEACH CA
90806-2777
US

IV. Provider business mailing address

701 E 28TH ST STE 301
LONG BEACH CA
90806-2777
US

V. Phone/Fax

Practice location:
  • Phone: 562-997-3020
  • Fax:
Mailing address:
  • Phone:
  • 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: MR. MARC FREIDMAN
Title or Position: MANAGER
Credential:
Phone: 562-997-3020