Provider Demographics
NPI:1114380706
Name:BEVERLY HILLS PREMIUM SURGERY
Entity Type:Organization
Organization Name:BEVERLY HILLS PREMIUM SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BELLA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHKLYARENKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-360-7368
Mailing Address - Street 1:99 N LA CIENEGA BLVD # 102A
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2222
Mailing Address - Country:US
Mailing Address - Phone:310-360-7368
Mailing Address - Fax:310-360-7370
Practice Address - Street 1:99 N LA CIENEGA BLVD # 102A
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2222
Practice Address - Country:US
Practice Address - Phone:310-360-7368
Practice Address - Fax:310-360-7370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-31
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical