Basic Information
| Provider Information | |||||||||
| NPI: | 1881642288 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DOHENY ENDOSURGICAL CENTER INC | ||||||||
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| OtherOrganizationName: | DOHENY ENDOSURGICAL CENTER | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9090 WILSHIRE BLVD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | BEVERLY HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902111848 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3102462555 | ||||||||
| FaxNumber: | 3102850819 | ||||||||
| Practice Location | |||||||||
| Address1: | 9090 WILSHIRE BLVD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | BEVERLY HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902111848 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3102462555 | ||||||||
| FaxNumber: | 3102850819 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2006 | ||||||||
| LastUpdateDate: | 08/31/2015 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ELLIS | ||||||||
| AuthorizedOfficialFirstName: | JONATHAN | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3105500400 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | 69377 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.