MEDICARE: AMNIOTTI INC

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	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1780465062
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMNIOTTI INC

Provider Business Mailing Address
First Line	:	113 N SAN VICENTE BLVD STE 368
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-2329
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	113 N SAN VICENTE BLVD STE 368
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-2329
Country	:	US
Telephone Number	:	866-316-9062
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DAVID COHEN
Credential	:
Telephone Number	:	866-316-9062

Provider Enumeration Date	:	10/11/2023
Last Update Date	:	11/17/2023

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Directions to “AMNIOTTI INC ” Practice Location

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