Healthcare Provider Details

I. General information

NPI: 1962154419
Provider Name (Legal Business Name): BEVERLY HILLS HEALTH AND AESTHETICS CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2022
Last Update Date: 01/25/2022
Certification Date: 01/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 S. BEVERLY DRIVE SUITE 111
LOS ANGELES CA
90035-1149
US

IV. Provider business mailing address

1125 S. BEVERLY DRIVE SUITE 111
LOS ANGELES CA
90035-1149
US

V. Phone/Fax

Practice location:
  • Phone: 310-277-9905
  • Fax: 310-277-9922
Mailing address:
  • Phone: 310-277-9905
  • Fax: 310-277-9922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARIO ROSENBURG
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 310-277-9905