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General NPI Number Information
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NPI Number | 1740695139
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Entity Type | Organization
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Legal Business Name | HOLLYWOOD LIFESTYLE DERMAOTOGY
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Dates
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Enumeration Date | 06/24/2014
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Last Update Date | 06/24/2014
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Provider Practice Location Address
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Address Line | 7135 HOLLYWOOD BLVD #306
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City | LOS ANGELES
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State | CA
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Zip | 90046-3212
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Country | US
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Telephone | 323-301-3378
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Fax | 213-256-0685
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Provider Business Mailing Address
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Address Line | 7135 HOLLYWOOD BLVD #306
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City | LOS ANGELES
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State | CA
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Zip | 90046-3212
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Country | US
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Telephone | 323-301-3378
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Fax | 213-256-0685
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL J SABAT
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Credential | D.O.
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Telephone | 323-600-4156
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 20A 8743
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License Number State | CA
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