Organization
BEVERLY MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICHOLAS N DZEBOLO M.D (CEO)
(132) 771-0302
Entity
Organization
Contact information
Practice address
2105 BEVERLY BLVD STE 233B, LOS ANGELES, CA 90057-2216
(213) 674-7859
(213) 277-1055
Mailing address
2105 BEVERLY BLVD STE 233B, LOS ANGELES, CA 90057-2216
(213) 674-7859
(213) 674-7863
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
05/07/2021
Last updated
06/23/2021
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