Healthcare Provider Details

I. General information

NPI: 1366808016
Provider Name (Legal Business Name): BEVERLY HILLS WELLNESS PHYSICIANS CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2016
Last Update Date: 01/15/2020
Certification Date: 01/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E 28TH ST STE 100
LONG BEACH CA
90806-2769
US

IV. Provider business mailing address

7230 MEDICAL CENTER DRIVE SUITE 100
WEST HILLS CA
91307
US

V. Phone/Fax

Practice location:
  • Phone: 562-426-2551
  • Fax: 818-337-2049
Mailing address:
  • Phone: 818-518-5980
  • Fax: 818-337-2049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: EDWARD BRENT LAUGESON
Title or Position: MANAGER
Credential:
Phone: 818-518-5980