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General NPI Number Information
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NPI Number | 1902238678
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Entity Type | Organization
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Legal Business Name | BEVERLY HILLS FITNESS GROUP, INC.
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Dates
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Enumeration Date | 08/05/2013
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Last Update Date | 09/12/2013
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Provider Practice Location Address
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Address Line | 13535 VALLEYHEART DR N
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City | SHERMAN OAKS
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State | CA
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Zip | 91423-3123
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Country | US
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Telephone | 310-927-2162
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Fax |
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Provider Business Mailing Address
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Address Line | 13535 VALLEYHEART DR N
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City | SHERMAN OAKS
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State | CA
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Zip | 91423-3123
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LEON JEREMY LAVIGNE
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Credential |
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Telephone | 310-927-2162
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246RP1900X
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Taxonomy Name | Phlebotomy Technician
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License Number | A052594
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | A052594
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License Number State | CA
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