Provider Demographics
NPI:1003269945
Name:BEVERLY HILLS HORMONE INSTITUTE INC.
Entity Type:Organization
Organization Name:BEVERLY HILLS HORMONE INSTITUTE INC.
Other - Org Name:BODYLOGICDO OF BEVERLY HILLS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:GORN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:512-571-2223
Mailing Address - Street 1:3701 EXECUTIVE CENTER DR
Mailing Address - Street 2:SUITE 211
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-1644
Mailing Address - Country:US
Mailing Address - Phone:512-571-2223
Mailing Address - Fax:
Practice Address - Street 1:9744 WILSHIRE BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-1828
Practice Address - Country:US
Practice Address - Phone:877-857-0146
Practice Address - Fax:877-510-4839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-15
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A14618261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty