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General NPI Number Information
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NPI Number | 1467747493
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Entity Type | Organization
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Legal Business Name | 90210 SURGERY CENTER
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Dates
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Enumeration Date | 06/17/2011
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Last Update Date | 06/17/2011
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Provider Practice Location Address
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Address Line | 436 N. BEDFORD DR., SUITE 200
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City | BEVERLY HILLS
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State | CA
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Zip | 90210
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Country | US
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Telephone | 310-777-0069
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Fax |
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Provider Business Mailing Address
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Address Line | 436 N BEDFORD DR STE 200
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City | BEVERLY HILLS
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State | CA
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Zip | 90210-4312
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Country | US
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Telephone | 310-777-0069
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Fax | 310-858-3150
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Authorized Official
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Title or Position | OWNER
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Name | DR. RENATO CALABRIA
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Credential | M,D.,
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Telephone | 310-777-0069
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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 | A43041
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License Number State | CA
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