Provider Demographics
NPI:1427417716
Name:THE ROXBURY INSTITUTE
Entity Type:Organization
Organization Name:THE ROXBURY INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:AMRON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:424-394-1610
Mailing Address - Street 1:450 N ROXBURY DR STE 400
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4218
Mailing Address - Country:US
Mailing Address - Phone:424-394-1610
Mailing Address - Fax:424-394-1610
Practice Address - Street 1:450 N ROXBURY DRIVE
Practice Address - Street 2:#400
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210
Practice Address - Country:US
Practice Address - Phone:424-394-1610
Practice Address - Fax:424-394-1628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-16
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG72788207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty