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General NPI Number Information
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NPI Number | 1255913661
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Entity Type | Organization
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Legal Business Name | BEVERLY CENTURY SURGICAL CENTER
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Dates
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Enumeration Date | 04/25/2021
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Last Update Date | 04/25/2021
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Provider Practice Location Address
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Address Line | 2080 CENTURY PARK E STE 509
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City | LOS ANGELES
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State | CA
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Zip | 90067-2008
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Country | US
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Telephone | 310-694-4486
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Fax | 310-363-7617
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Provider Business Mailing Address
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Address Line | 2080 CENTURY PARK E STE 501
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City | LOS ANGELES
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State | CA
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Zip | 90067-2008
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Country | US
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Telephone | 310-694-4486
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Fax | 310-363-7617
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Authorized Official
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Title or Position | PRESIDENT
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Name | BABAK MOEINOLMOLKI
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Credential | MD
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Telephone | 443-831-2561
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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