Healthcare Provider Details

I. General information

NPI: 1962929224
Provider Name (Legal Business Name): GLENDALE SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2017
Last Update Date: 07/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11851 NORTH 51ST AVE SUITE G
GLENDALE AZ
85304
US

IV. Provider business mailing address

26500 AGOURA RD STE 102-587
CALABASAS CA
91302-1952
US

V. Phone/Fax

Practice location:
  • Phone: 602-362-3035
  • Fax:
Mailing address:
  • Phone: 818-880-8605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TIM MURPHY
Title or Position: VP OPERATIONS
Credential:
Phone: 818-880-8605