Provider Demographics
NPI:1124301973
Name:BEVERLY HILLS PAIN INSTITUTE & NEUROLOGY CORPORATION
Entity type:Organization
Organization Name:BEVERLY HILLS PAIN INSTITUTE & NEUROLOGY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GLADYS
Authorized Official - Middle Name:
Authorized Official - Last Name:HAPPER
Authorized Official - Suffix:
Authorized Official - Credentials:NPA
Authorized Official - Phone:310-888-2877
Mailing Address - Street 1:PO BOX 12843
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90295-3843
Mailing Address - Country:US
Mailing Address - Phone:310-888-2877
Mailing Address - Fax:310-205-9258
Practice Address - Street 1:415 N CRESCENT DR STE 220
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-6810
Practice Address - Country:US
Practice Address - Phone:310-888-2877
Practice Address - Fax:310-205-9258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP12236208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1912160623OtherNPI NUMBER