MEDICARE: DR. MILLICENT OVERLEY ROVELO M.D.

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	390200000X	Student in an Organized Health Care Education/Training Program
2	208200000X	Plastic Surgery Physician	A130080	CA

General Provider Information

NPI Number	:	1326280371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MILLICENT OVERLEY ROVELO M.D.

Provider Business Mailing Address
First Line	:	465 N ROXBURY DR STE 1001
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90210-4213
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	465 N ROXBURY DR STE 1001
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90210-4213
Country	:	US
Telephone Number	:	310-954-1355
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2009
Last Update Date	:	03/17/2018

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