Provider Demographics
NPI:1629192133
Name:SHEREEN BEVERLY, M.D. INC.
Entity Type:Organization
Organization Name:SHEREEN BEVERLY, M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHEREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BEVERLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-676-7000
Mailing Address - Street 1:4455 W 117TH ST
Mailing Address - Street 2:SUITE 506
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-2241
Mailing Address - Country:US
Mailing Address - Phone:310-676-7000
Mailing Address - Fax:310-676-0300
Practice Address - Street 1:4455 W 117TH ST
Practice Address - Street 2:SUITE 506
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-2241
Practice Address - Country:US
Practice Address - Phone:310-676-7000
Practice Address - Fax:310-676-0300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG68251207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty