Provider Demographics
NPI:1609279306
Name:BEVERLY HILLS ALLERGY
Entity Type:Organization
Organization Name:BEVERLY HILLS ALLERGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO/MD
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERWIN
Authorized Official - Middle Name:RAMON
Authorized Official - Last Name:HARIRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-499-8116
Mailing Address - Street 1:6310 SAN VICENTE BLVD
Mailing Address - Street 2:220
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5426
Mailing Address - Country:US
Mailing Address - Phone:310-499-8116
Mailing Address - Fax:310-388-5898
Practice Address - Street 1:6310 SAN VICENTE BLVD
Practice Address - Street 2:220
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5426
Practice Address - Country:US
Practice Address - Phone:310-499-8116
Practice Address - Fax:310-388-5898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-08
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA108924207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA108924Medicare Oscar/Certification