Organization
LAWRENCE RIVKIN MD A MED CORP
Active
Organization
LAWRENCE RIVKIN MD A MED CORP
Active
Other names
DERMATOLOGY ASSOICATES MEDCIAL GROUP
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARIA E ANZALDO (OFFICE MANAGER)
(310) 274-9954
Entity
Organization
Contact information
Practice address
465 N ROXBURY DR STE 803, BEVERLY HILLS, CA 90210-4211
(310) 274-9954
(310) 274-9450
Mailing address
465 N ROXBURY DR STE 803, BEVERLY HILLS, CA 90210-4211
(310) 274-9954
(310) 274-9450
Taxonomy
Speciality
Code
Description
License number
State
207NS0135X
Procedural Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C34985
STATE LICENSE
CA
01
—
G042740
STATE LICENSE
CA
01
—
G56013
STATE LICENSE
CA
01
—
G76489
STATE LICENSE
CA
01
—
W11012
GROUP # MEDICARE
CA
01
—
WC34985B
MEDICARE PROVIDER #
CA
Enumeration date
09/21/2006
Last updated
03/07/2023
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