Healthcare Provider Details

I. General information

NPI: 1316455165
Provider Name (Legal Business Name): ELITE OUTPATIENT SURGERY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2018
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 N LA CIENEGA BLVD STE 150
BEVERLY HILLS CA
90211-3143
US

IV. Provider business mailing address

50 N LA CIENEGA BLVD STE 150
BEVERLY HILLS CA
90211-3143
US

V. Phone/Fax

Practice location:
  • Phone: 747-477-1410
  • Fax: 747-477-1412
Mailing address:
  • Phone: 747-477-1410
  • Fax: 747-477-1412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number6656
License Number StateCA

VIII. Authorized Official

Name: MOHAMMAD R KHOSRAVI
Title or Position: CEO
Credential: MD
Phone: 747-477-1410