Healthcare Provider Details

I. General information

NPI: 1336498948
Provider Name (Legal Business Name): BEVERLY HILLS NUTRITION AND INTERNAL MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2012
Last Update Date: 08/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6320 COMMODORE SLOAT DR
LOS ANGELES CA
90048-5453
US

IV. Provider business mailing address

838 N DOHENY DR PENTHOUSE A
WEST HOLLYWOOD CA
90069-4853
US

V. Phone/Fax

Practice location:
  • Phone: 323-935-3420
  • Fax:
Mailing address:
  • Phone: 310-385-9171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberG55448
License Number StateCA

VIII. Authorized Official

Name: ANDREW SILVER
Title or Position: DIRECTOR
Credential:
Phone: 310-385-9171