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General NPI Number Information
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NPI Number | 1356494512
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Entity Type | Organization
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Legal Business Name | BEDFORD AMBULATORY SURGERY CENTER
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 10/21/2011
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Provider Practice Location Address
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Address Line | 436 N BEDFORD DR STE. 215
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City | BEVERLY HILLS
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State | CA
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Zip | 90210-4310
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Country | US
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Telephone | 310-247-1932
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Fax | 310-247-8140
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Provider Business Mailing Address
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Address Line | 436 N BEDFORD DR STE 215
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City | BEVERLY HILLS
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State | CA
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Zip | 90210-4310
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Country | US
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Telephone | 310-247-1932
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Fax | 310-247-8140
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Authorized Official
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Title or Position | OWNER
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Name | DR. NICHOLAS R. NIKOLOV
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Credential | IM.D.
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Telephone | 310-247-1932
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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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