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General NPI Number Information
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NPI Number | 1124017496
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Entity Type | Organization
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Legal Business Name | DEAUVILLE MEDICAL GROUP INC
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Dates
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Enumeration Date | 10/19/2005
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Last Update Date | 06/10/2019
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Provider Practice Location Address
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Address Line | 292 S LA CIENEGA BLVD STE 202
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City | BEVERLY HILLS
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State | CA
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Zip | 90211-3393
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Country | US
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Telephone | 213-304-3512
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Fax | 323-525-0490
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Provider Business Mailing Address
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Address Line | 7190 W SUNSET BLVD #243
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City | LOS ANGELES
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State | CA
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Zip | 90046-4415
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Country | US
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Telephone | 323-655-6250
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Fax | 323-655-1619
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MELVIN FAIGUS
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Credential | M.D.
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Telephone | 310-358-9000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | G11324
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License Number State | CA
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