Healthcare Provider Details

I. General information

NPI: 1558881771
Provider Name (Legal Business Name): BEL AIR SURGICAL INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11847 WILSHIRE BLVD STE 302
LOS ANGELES CA
90025-6634
US

IV. Provider business mailing address

11847 WILSHIRE BLVD STE 302
LOS ANGELES CA
90025-6634
US

V. Phone/Fax

Practice location:
  • Phone: 310-477-3954
  • Fax: 310-473-5103
Mailing address:
  • Phone: 310-477-3954
  • Fax: 310-473-5103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. HOWARD WEINSTEIN
Title or Position: MEDICAL BILLER/ADMINISTRATOR
Credential:
Phone: 818-207-2483