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General NPI Number Information
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NPI Number | 1144791500
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Entity Type | Organization
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Legal Business Name | BEVERLY COMMUNITY CLINIC
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Dates
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Enumeration Date | 12/11/2018
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Last Update Date | 03/19/2024
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Provider Practice Location Address
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Address Line | 2252 BEVERLY BLVD STE 103
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City | LOS ANGELES
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State | CA
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Zip | 90057-2246
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Country | US
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Telephone | 213-674-7424
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Fax |
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Provider Business Mailing Address
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Address Line | 2252 BEVERLY BLVD STE 103
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City | LOS ANGELES
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State | CA
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Zip | 90057-2246
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Country | US
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Telephone | 213-674-7424
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Fax |
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Authorized Official
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Title or Position | CHIEF MEDICAL OFFICER
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Name | DR. JOHN BURNS
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Credential | MD
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Telephone | 213-674-7424
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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