Healthcare Provider Details

I. General information

NPI: 1932786928
Provider Name (Legal Business Name): ACTIVE SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 03/25/2021
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 N 5TH AVE STE 301D
ARCADIA CA
91006-3710
US

IV. Provider business mailing address

PO BOX 8323
LA CRESCENTA CA
91224-0323
US

V. Phone/Fax

Practice location:
  • Phone: 626-460-1096
  • Fax: 888-425-9079
Mailing address:
  • Phone: 818-338-6860
  • Fax: 888-425-9079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: MAXIM MORADIAN
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 818-338-6860