Provider Demographics
NPI:1336498948
Name:BEVERLY HILLS NUTRITION AND INTERNAL MEDICINE
Entity Type:Organization
Organization Name:BEVERLY HILLS NUTRITION AND INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:SILVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-385-9171
Mailing Address - Street 1:838 N DOHENY DR
Mailing Address - Street 2:PENTHOUSE A
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-4853
Mailing Address - Country:US
Mailing Address - Phone:310-385-9171
Mailing Address - Fax:
Practice Address - Street 1:6320 COMMODORE SLOAT DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5453
Practice Address - Country:US
Practice Address - Phone:323-935-3420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG55448261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service