Organization
MODERN INSTITUE OF SURGERY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. IVAILO DIMOV M.D. (MEDICAL DIRECTOR)
(310) 278-0077
Entity
Organization
Contact information
Practice address
9090 BURTON WAY, BEVERLY HILLS, CA 90211-1661
(310) 278-0077
Mailing address
9090 BURTON WAY, BEVERLY HILLS, CA 90211-1661
(310) 278-0077
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
C3580319
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000000000
MEDICARE
CA
Enumeration date
09/27/2013
Last updated
12/06/2013
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