Basic Information
| Provider Information | |||||||||
| NPI: | 1205968070 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BEVERLY HILLS SUNSET SURGERY CENTER, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9201 W. SUNSET BLVD | ||||||||
| Address2: | STE 405 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108871730 | ||||||||
| FaxNumber: | 3108871734 | ||||||||
| Practice Location | |||||||||
| Address1: | 9201 W SUNSET BLVD | ||||||||
| Address2: | SUITE 405 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900693701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108871730 | ||||||||
| FaxNumber: | 3108871734 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2007 | ||||||||
| LastUpdateDate: | 06/21/2018 | ||||||||
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| AuthorizedOfficialLastName: | MATLOCK | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF OPERATIONS OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 3108871730 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 284300000X | S051348 | CA | Y | Hospitals | Special Hospital |
ID Information
| ID | Type | State | Issuer | Description | ZZZH1943Z | 01 | CA | BLUE SHIELD | OTHER |