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General NPI Number Information
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NPI Number | 1588234561
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Entity Type | Organization
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Legal Business Name | BEVERLY HILLS MEDICAL INSTITUTE CORPORATION
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Dates
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Enumeration Date | 06/30/2021
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Last Update Date | 06/30/2021
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Provider Practice Location Address
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Address Line | 8635 W 3RD ST STE 865W
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City | LOS ANGELES
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State | CA
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Zip | 90048-6140
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Country | US
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Telephone | 310-688-8080
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Fax | 310-688-8081
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Provider Business Mailing Address
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Address Line | 621 N HILLCREST RD
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City | BEVERLY HILLS
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State | CA
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Zip | 90210-3514
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Country | US
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Telephone | 310-688-8080
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Fax | 310-688-8081
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Authorized Official
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Title or Position | PRESIDENT
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Name | SHAGHAYEGH TAVASSOLI
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Credential | MD
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Telephone | 310-688-8080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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