Organization Active NPI

R Ray Nettles MD Inc

  • Family Medicine Physician
  • Beverly Hills, CA
National Provider Identifier
1093243479
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A79597 Issued in AL
Legal business name
R RAY NETTLES MD INC
Practice address
9454 Wilshire Blvd Ste 300
Beverly Hills, CA 90212-2904
Phone
(310) 601-4778
Fax
(800) 877-3725
NPI assigned
May 30, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Lorena B Mandi
Title
Secretary
Phone
(310) 601-4778

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X A79597 AL Primary

Addresses

Primary practice location

9454 Wilshire Blvd Ste 300
Beverly Hills, CA 90212-2904

Mailing address

9454 Wilshire Blvd Ste 300
Beverly Hills, CA 90212-2904
Phone (310) 601-4778

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1496102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1093243479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9454 WILSHIRE BLVD STE 300",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "902122904",
            "telephone_number": "310-601-4778",
            "fax_number": "800-877-3725"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9454 WILSHIRE BLVD STE 300",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "902122904",
            "telephone_number": "310-601-4778",
            "fax_number": "800-877-3725"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "R RAY NETTLES MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-30",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "MANDI",
        "authorized_official_first_name": "LORENA",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "310-601-4778"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "AL",
            "license": "A79597",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Beverly Hills, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.