Provider Demographics
NPI:1235663261
Name:DR. MILLICENT ROVELO
Entity Type:Organization
Organization Name:DR. MILLICENT ROVELO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MILLICENT
Authorized Official - Middle Name:OVERLEY
Authorized Official - Last Name:ROVELO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-403-0562
Mailing Address - Street 1:465 N ROXBURY DR STE 1001
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4213
Mailing Address - Country:US
Mailing Address - Phone:310-954-1355
Mailing Address - Fax:310-248-6256
Practice Address - Street 1:465 N ROXBURY DR STE 1001
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4213
Practice Address - Country:US
Practice Address - Phone:310-954-1355
Practice Address - Fax:310-248-6256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1300802086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty