NPIMap

Organization Active NPI

Mobile Executive Healthcare Cosmetic and Rejuvenation Medical

  • Surgery Physician
  • Los Angeles, CA
National Provider Identifier
1083411664
Registry record updated Feb 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
MOBILE EXECUTIVE HEALTHCARE COSMETIC AND REJUVENATION MEDICAL
Practice address
1425 W Manchester Ave Ste a
Los Angeles, CA 90047-5436
Phone
(310) 242-7400
NPI assigned
Feb 28, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Daniel Davidson, PHD
Title
Administrator
Phone
(310) 212-1500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X Primary

Addresses

Primary practice location

1425 W Manchester Ave Ste a
Los Angeles, CA 90047-5436

Mailing address

1270 S Alfred St # 1064
Los Angeles, CA 90035-2506
Phone (310) 212-1500

Other names 1

  • YOUTHNLOOKS Other name

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1740700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740700800000",
    "number": "1083411664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1270 S ALFRED ST # 1064",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900352506",
            "telephone_number": "310-212-1500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1425 W MANCHESTER AVE STE A",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900475436",
            "telephone_number": "310-242-7400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOBILE EXECUTIVE HEALTHCARE COSMETIC AND REJUVENATION MEDICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-02-28",
        "last_updated": "2025-02-28",
        "certification_date": "2025-02-28",
        "status": "A",
        "authorized_official_last_name": "DAVIDSON",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "310-212-1500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "YOUTHNLOOKS",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.