Provider Demographics
NPI:1053719773
Name:BEVERLY HILLS SURGICAL & MEDICAL CENTER
Entity type:Organization
Organization Name:BEVERLY HILLS SURGICAL & MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FARDAD
Authorized Official - Middle Name:
Authorized Official - Last Name:FOROUZANPOUR
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:310-360-0504
Mailing Address - Street 1:8500 WILSHIRE BLVD STE 1020
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-3108
Mailing Address - Country:US
Mailing Address - Phone:310-360-0504
Mailing Address - Fax:
Practice Address - Street 1:8500 WILSHIRE BLVD STE 1020
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-3108
Practice Address - Country:US
Practice Address - Phone:310-360-0504
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-11
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2OA7188261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical