Provider Demographics
NPI:1366808016
Name:BEVERLY HILLS WELLNESS PHYSICIANS CORP
Entity type:Organization
Organization Name:BEVERLY HILLS WELLNESS PHYSICIANS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:BRENT
Authorized Official - Last Name:LAUGESON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-518-5980
Mailing Address - Street 1:7230 MEDICAL CENTER DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307
Mailing Address - Country:US
Mailing Address - Phone:818-518-5980
Mailing Address - Fax:818-337-2049
Practice Address - Street 1:701 E 28TH ST STE 100
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2769
Practice Address - Country:US
Practice Address - Phone:562-426-2551
Practice Address - Fax:818-337-2049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-11
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy