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General NPI Number Information
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NPI Number | 1356562730
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Entity Type | Organization
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Legal Business Name | JACK DITLOVE, MD
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 435 N ROXBURY DR STE 102
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City | BEVERLY HILLS
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State | CA
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Zip | 90210-5003
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Country | US
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Telephone | 310-273-1150
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Fax |
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Provider Business Mailing Address
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Address Line | 435 N ROXBURY DR STE 102
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City | BEVERLY HILLS
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State | CA
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Zip | 90210-5003
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Country | US
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Telephone | 310-273-1150
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Fax |
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | PAM CALDERON
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Credential |
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Telephone | 310-343-8884
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State | CA
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