Healthcare Provider Details

I. General information

NPI: 1689059602
Provider Name (Legal Business Name): HELENA FOTIOU MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2015
Last Update Date: 07/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 BEVERLY BLVD
WEST HOLLYWOOD CA
90048-1804
US

IV. Provider business mailing address

269 S BEVERLY DR SUITE 290
BEVERLY HILLS CA
90212-3851
US

V. Phone/Fax

Practice location:
  • Phone: 609-915-0800
  • Fax:
Mailing address:
  • Phone: 609-915-0800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA128464
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA128464
License Number StateCA

VIII. Authorized Official

Name: HELENA FOTIOU
Title or Position: OWNER / PRESIDENT
Credential: MD
Phone: 609-915-0800