Provider Demographics
NPI:1801490891
Name:BEVERLY HILLS WELLNESS CENTER INC
Entity type:Organization
Organization Name:BEVERLY HILLS WELLNESS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:REUBEN
Authorized Official - Last Name:VENNING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-278-4567
Mailing Address - Street 1:6360 WILSHIRE BLVD STE 409
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5606
Mailing Address - Country:US
Mailing Address - Phone:310-278-4567
Mailing Address - Fax:310-861-5255
Practice Address - Street 1:6360 WILSHIRE BLVD STE 409
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5606
Practice Address - Country:US
Practice Address - Phone:310-278-4567
Practice Address - Fax:310-861-5255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-30
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathologyGroup - Multi-Specialty