MEDICARE: BEVERLY HILLS ADVANCED SURGERY INSTITUTE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center		CA

General Provider Information

NPI Number	:	1245326974
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEVERLY HILLS ADVANCED SURGERY INSTITUTE

Provider Business Mailing Address
First Line	:	120 S SPALDING DR STE 100
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90212-1830
Country	:	US
Telephone Number	:	310-274-8228
Fax Number	:	310-516-9661

Provider Business Practice Location Address
First Line	:	120 S SPALDING DR STE 100
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90212-1830
Country	:	US
Telephone Number	:	310-274-8228
Fax Number	:	310-516-9661

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	ELENA JASSO
Credential	:
Telephone Number	:	310-323-3041

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	08/22/2020

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