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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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