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General NPI Number Information
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NPI Number | 1205191970
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Entity Type | Organization
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Legal Business Name | BEVERLY HILLS VEIN CLINIC LLC
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Dates
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Enumeration Date | 07/09/2012
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Last Update Date | 12/09/2012
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Provider Practice Location Address
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Address Line | 1013 S PACIFIC COAST HWY
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City | REDONDO BEACH
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State | CA
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Zip | 90277-4756
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Country | US
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Telephone | 310-920-9723
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Fax |
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Provider Business Mailing Address
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Address Line | 1013 S PACIFIC COAST HWY
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City | REDONDO BEACH
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State | CA
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Zip | 90277-4756
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Country | US
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Telephone | 310-920-9723
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Fax |
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | MR. RICHARD D MATTHEWS
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Credential |
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Telephone | 928-606-3981
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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