Provider Demographics
NPI:1477622199
Name:BEVERLY HILLS ANESTHESIA, INC
Entity Type:Organization
Organization Name:BEVERLY HILLS ANESTHESIA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:CHEVLEN
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:310-274-7515
Mailing Address - Street 1:269 S BEVERLY DR
Mailing Address - Street 2:PMB 228
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-3807
Mailing Address - Country:US
Mailing Address - Phone:310-274-7515
Mailing Address - Fax:310-274-2469
Practice Address - Street 1:8635 W 3RD ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-6101
Practice Address - Country:US
Practice Address - Phone:310-274-7515
Practice Address - Fax:310-274-2469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANA134367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ47837ZOtherBLUE SHIELD
CAZZZ47837ZOtherBLUE SHIELD