Healthcare Provider Details

I. General information

NPI: 1083322689
Provider Name (Legal Business Name): CARDIOVASCULAR SURGICENTER OF BEVERLY HILLS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2022
Last Update Date: 11/17/2022
Certification Date: 11/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8741 ALDEN DR STE C
LOS ANGELES CA
90048-3692
US

IV. Provider business mailing address

8741 ALDEN DR STE C
LOS ANGELES CA
90048-3692
US

V. Phone/Fax

Practice location:
  • Phone: 310-652-2744
  • Fax:
Mailing address:
  • Phone: 310-652-2744
  • 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: DR. MEHRAN KHOSRANDI
Title or Position: MEMBER, GOVERNING BODY
Credential: MD
Phone: 310-652-2744