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General NPI Number Information
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NPI Number | 1801384987
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Entity Type | Organization
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Legal Business Name | EOS WELLNESS SURGERY CENTER LLC
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Dates
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Enumeration Date | 04/25/2018
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Last Update Date | 04/25/2018
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Provider Practice Location Address
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Address Line | 8641 WILSHIRE BLVD STE 305
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City | BEVERLY HILLS
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State | CA
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Zip | 90211-2921
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Country | US
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Telephone | 310-730-1218
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Fax | 310-861-1053
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Provider Business Mailing Address
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Address Line | 8641 WILSHIRE BLVD STE 305
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City | BEVERLY HILLS
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State | CA
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Zip | 90211-2921
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Country | US
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Telephone | 310-730-1218
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Fax | 310-861-1053
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Authorized Official
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Title or Position | ACCREDITATION COORDINATOR
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Name | LUANA FARRAR
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Credential |
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Telephone | 949-337-3267
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | A112498
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License Number State | CA
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