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General NPI Number Information
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NPI Number | 1427482173
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Entity Type | Organization
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Legal Business Name | BEVERLY HILLS LASKY SURGICENTER
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Dates
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Enumeration Date | 08/29/2013
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 160 S LASKY DR
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City | BEVERLY HILLS
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State | CA
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Zip | 90212-1704
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Country | US
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Telephone | 310-566-5663
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Fax |
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Provider Business Mailing Address
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Address Line | 160 S LASKY DR
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City | BEVERLY HILLS
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State | CA
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Zip | 90212-1704
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Country | US
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Telephone | 310-566-5663
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Fax |
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Authorized Official
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Title or Position | CHAIRMAN CREDENTIALING COMMITTE
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Name | MR. THOMAS C CLOUD III
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Credential | MPH
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Telephone | 323-301-2178
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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 | CA
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