Provider Demographics
NPI:1346420312
Name:SAFVATI BEVERLY HILLS MEDICAL CORPORATION
Entity Type:Organization
Organization Name:SAFVATI BEVERLY HILLS MEDICAL CORPORATION
Other - Org Name:BEVERLY HILLS URGENT CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:SHAHRIAR
Authorized Official - Middle Name:
Authorized Official - Last Name:SAFVATI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-659-0666
Mailing Address - Street 1:242 S ROBERTSON BLVD
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2811
Mailing Address - Country:US
Mailing Address - Phone:310-659-0666
Mailing Address - Fax:310-659-8754
Practice Address - Street 1:540 S MARENGO AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-3130
Practice Address - Country:US
Practice Address - Phone:626-397-4910
Practice Address - Fax:626-397-4911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA88634207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA88634OtherMED LIC
CAI28852Medicare UPIN