NPIMap

Organization Active NPI

Brentview Medical Inc.

  • Urgent Care Clinic/Center
  • Los Angeles, CA
National Provider Identifier
1447581350
Registry record updated Oct 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
Legal business name
BRENTVIEW MEDICAL INC.
Practice address
11611 San Vicente Blvd
Ground Floor
Los Angeles, CA 90049-5106
Phone
(310) 820-0013
Fax
(310) 207-2630
NPI assigned
Jan 18, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2021

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

Authorized official

Name
Raphael Darvish, MDNPI 1245457811
Title
Authorized Official
Phone
(310) 826-2555

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urgent Care Clinic/Center 261QU0200X Primary

Addresses

Primary practice location

11611 San Vicente Blvd
Ground Floor
Los Angeles, CA 90049-5106

Mailing address

11611 San Vicente Blvd
Ground Floor
Los Angeles, CA 90049-5106
Phone (310) 820-0013

Other practice location 1

8264 Santa Monica Blvd
West Hollywood, CA 90046-5915
Phone (323) 522-2222

Other names 1

  • Brentview Medical Urgent Care Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100826000754 CA Part B Supplier - Clinic/Group Practice 6608990742 Receives reassigned benefits from 31 practitioners
Practice locations: Los Angeles, CA; West Hollywood, CA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D0713845Brentview Medical11611 San Vicente Blvd, Los Angeles, CA 90049Certificate of waiverAug 19, 2026

National Provider Directory

National Provider Directory

Locations

11611 San Vicente Blvd
Ste 100
Los Angeles, CA 90049

11611 San Vicente Blvd
Los Angeles, CA 90049
Phone (310) 447-6060

11611 San Vicente Blvd
Lbby
Los Angeles, CA 90049
Phone (310) 820-0013

8264 Santa Monica Blvd
West Hollywood, CA 90046
Phone (323) 522-2222

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 33

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

View all 33

NPI Registry JSON

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

{
    "created_epoch": "1263772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634774400000",
    "number": "1447581350",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11611 SAN VICENTE BLVD",
            "address_2": "GROUND FLOOR",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900495106",
            "telephone_number": "310-820-0013",
            "fax_number": "310-207-2630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11611 SAN VICENTE BLVD",
            "address_2": "GROUND FLOOR",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900495106",
            "telephone_number": "310-820-0013",
            "fax_number": "310-207-2630"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8264 Santa Monica Blvd",
            "address_purpose": "LOCATION",
            "city": "West Hollywood",
            "state": "CA",
            "postal_code": "900465915",
            "country_code": "US",
            "telephone_number": "323-522-2222",
            "fax_number": "323-654-2221",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BRENTVIEW MEDICAL INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-18",
        "last_updated": "2021-10-21",
        "certification_date": "2021-10-21",
        "status": "A",
        "authorized_official_last_name": "DARVISH",
        "authorized_official_first_name": "RAPHAEL",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "310-826-2555",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brentview Medical Urgent Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Oct 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.