Healthcare Provider Details

I. General information

NPI: 1710294277
Provider Name (Legal Business Name): BEVERLY HILLS AESTHETIC FOOT SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2010
Last Update Date: 09/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12265 VENTURA BLVD NO. 107
STUDIO CITY CA
91604-2528
US

IV. Provider business mailing address

12265 VENTURA BLVD NO. 107
STUDIO CITY CA
91604-2528
US

V. Phone/Fax

Practice location:
  • Phone: 310-691-5411
  • Fax: 310-388-1658
Mailing address:
  • Phone: 310-691-5411
  • Fax: 310-388-1658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberE4318
License Number StateCA

VIII. Authorized Official

Name: DR. ALI SADRIEH
Title or Position: OWNER
Credential: DPM
Phone: 310-691-5411