Provider Demographics
NPI:1326631177
Name:BRENTVIEW MEDICAL INC.
Entity Type:Organization
Organization Name:BRENTVIEW MEDICAL INC.
Other - Org Name:BRENTVIEW MEDICAL URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:RAPHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DARVISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-826-2555
Mailing Address - Street 1:11611 SAN VICENTE BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-5106
Mailing Address - Country:US
Mailing Address - Phone:310-820-0013
Mailing Address - Fax:310-207-2630
Practice Address - Street 1:8264 SANTA MONICA BLVD
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-5915
Practice Address - Country:US
Practice Address - Phone:323-522-2222
Practice Address - Fax:323-654-2221
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRENTVIEW MEDICAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-02-12
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care