Provider Demographics
NPI:1205968070
Name:BEVERLY HILLS SUNSET SURGERY CENTER, INC
Entity type:Organization
Organization Name:BEVERLY HILLS SUNSET SURGERY CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MATLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-887-1730
Mailing Address - Street 1:9201 W. SUNSET BLVD
Mailing Address - Street 2:STE 405
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90069
Mailing Address - Country:US
Mailing Address - Phone:310-887-1730
Mailing Address - Fax:310-887-1734
Practice Address - Street 1:9201 W SUNSET BLVD
Practice Address - Street 2:SUITE 405
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90069-3701
Practice Address - Country:US
Practice Address - Phone:310-887-1730
Practice Address - Fax:310-887-1734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAS051348284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZH1943ZOtherBLUE SHIELD
CA=========OtherBLUE CROSS