=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679995559
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | 9301 WILSHIRE SURGERY INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/13/2014
-----------------------------------------------------
Last Update Date | 01/13/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9301 WILSHIRE BLVD SUITE 301
-----------------------------------------------------
City | BEVERLY HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90210-5424
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-273-3647
-----------------------------------------------------
Fax | 310-273-5601
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9301 WILSHIRE BLVD SUITE 301
-----------------------------------------------------
City | BEVERLY HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90210-5424
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-273-3647
-----------------------------------------------------
Fax | 310-273-5601
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | ARMAND NEWMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 310-273-3647
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------