Healthcare Provider Details

I. General information

NPI: 1174084818
Provider Name (Legal Business Name): ERSNO EROMO MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 05/28/2023
Certification Date: 05/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1513 S GRAND AVE
LOS ANGELES CA
90015-3070
US

IV. Provider business mailing address

8447 WILSHIRE BLVD STE 204
BEVERLY HILLS CA
90211-3207
US

V. Phone/Fax

Practice location:
  • Phone: 310-704-9880
  • Fax:
Mailing address:
  • Phone: 310-929-6336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ERSNO EROMO
Title or Position: CEO
Credential: MD
Phone: 310-704-9880