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General NPI Number Information
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NPI Number | 1447581350
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Entity Type | Organization
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Legal Business Name | BRENTVIEW MEDICAL INC.
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Dates
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Enumeration Date | 01/18/2010
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Last Update Date | 10/21/2021
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Provider Practice Location Address
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Address Line | 11611 SAN VICENTE BLVD GROUND FLOOR
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City | LOS ANGELES
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State | CA
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Zip | 90049-5106
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Country | US
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Telephone | 310-820-0013
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Fax | 310-207-2630
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Provider Business Mailing Address
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Address Line | 11611 SAN VICENTE BLVD GROUND FLOOR
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City | LOS ANGELES
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State | CA
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Zip | 90049-5106
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Country | US
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Telephone | 310-820-0013
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Fax | 310-207-2630
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | RAPHAEL DARVISH
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Credential | MD
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Telephone | 310-826-2555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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