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General NPI Number Information
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NPI Number | 1710497268
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Entity Type | Organization
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Legal Business Name | BEVERLY HILLS REJUVENATION CENTER
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Dates
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Enumeration Date | 10/10/2017
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Last Update Date | 10/10/2017
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Provider Practice Location Address
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Address Line | 1860 S SEPULVEDA BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90025-4314
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Country | US
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Telephone | 310-473-5800
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Fax | 310-473-5801
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Provider Business Mailing Address
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Address Line | 1860 S SEPULVEDA BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90025-4314
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Country | US
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Telephone | 310-473-5800
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Fax | 310-473-5801
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. ENRICO J DIRIENZO SR.
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Credential | MD
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Telephone | 310-473-5800
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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 | G134479
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License Number State | CA
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