# R RAY NETTLES MD INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1699204032
- **Authorized official:** LORENA B MANDI (SECRETARY)
- **Authorized official phone:** (310) 601-4778

## Contact information

- **Practice address:** 9454 WILSHIRE BLVD, \#300, BEVERLY HILLS, CA 90212
- **Practice address phone:** (310) 601-4778
- **Practice address fax:** (800) 877-3725
- **Mailing address:** 9454 WILSHIRE BLVD STE 300, BEVERLY HILLS, CA 90212-2904
- **Mailing address phone:** (310) 601-4778
- **Mailing address fax:** (800) 877-3725

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/08/2017
- **Last updated:** 07/21/2022