Beverly Medical Group

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

BEVERLY MEDICAL GROUP

Practice address

2105 Beverly Blvd Ste 233B
Los Angeles, CA 90057-2216

Phone

(213) 674-7859

Fax

(213) 277-1055

NPI assigned

May 7, 2021

Organization subpart

No

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

Authorized official

Name

Nicholas N Dzebolo, M.D

Title

Ceo

Phone

(132) 771-0302

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1620345600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624406400000",
    "number": "1326622143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2105 BEVERLY BLVD STE 233B",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900572216",
            "telephone_number": "213-674-7859",
            "fax_number": "213-674-7863"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2105 BEVERLY BLVD STE 233B",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900572216",
            "telephone_number": "213-674-7859",
            "fax_number": "213-277-1055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEVERLY MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-07",
        "last_updated": "2021-06-23",
        "certification_date": "2021-06-23",
        "status": "A",
        "authorized_official_last_name": "DZEBOLO",
        "authorized_official_first_name": "NICHOLAS",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "132-771-0302",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Beverly Hills Wellness Center Inc
• Beverly Hills Womens Center
• Beverly Hills Womens Health a Professional Corp
• Beverly Mason Serenity Living
• Beverly Mason Serenity Living
• Beverly Mental Health Service
• Beverly Multispecialty Clinic Inc
• Beverly OB & GYN Medical Center Inc.
• Beverly Orthopedic Laboratory Inc
• Beverly Radiology Medical Group (Westchester Advanced Imaging)

• Clinic/Center in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2021; 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.