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General NPI Number Information
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NPI Number | 1508707324
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Entity Type | Organization
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Legal Business Name | VITREORETINA INC
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Dates
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Enumeration Date | 04/04/2026
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Last Update Date | 04/04/2026
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Provider Practice Location Address
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Address Line | 9735 WILSHIRE BLVD STE 219
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City | BEVERLY HILLS
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State | CA
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Zip | 90212-2110
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Country | US
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Telephone | 310-877-3330
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Fax | 818-552-5044
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Provider Business Mailing Address
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Address Line | 9735 WILSHIRE BLVD STE 219
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City | BEVERLY HILLS
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State | CA
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Zip | 90212-2110
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Country | US
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Telephone | 310-877-3330
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Fax | 818-552-5044
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL JAVAHERI
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Credential | MD
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Telephone | 310-877-3330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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