Basic Information
| Provider Information | |||||||||
| NPI: | 1972937001 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BEVERLY HILLS SPINE AND PAIN INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1420 S BUNDY DR | ||||||||
| Address2: | APT #203 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900256183 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3106175060 | ||||||||
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| Practice Location | |||||||||
| Address1: | 444 S SAN VICENTE BLVD | ||||||||
| Address2: | SUITE #800 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900484165 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3104239900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2013 | ||||||||
| LastUpdateDate: | 08/26/2013 | ||||||||
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| AuthorizedOfficialLastName: | BERKLEY | ||||||||
| AuthorizedOfficialFirstName: | JASON | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3104239900 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0014X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
No ID Information.