Healthcare Provider Details

I. General information

NPI: 1831748482
Provider Name (Legal Business Name): GOLDEN TRIANGLE SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2019
Last Update Date: 09/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 N ROXBURY DR STE 207
BEVERLY HILLS CA
90210-5017
US

IV. Provider business mailing address

436 N ROXBURY DR STE 207
BEVERLY HILLS CA
90210-5017
US

V. Phone/Fax

Practice location:
  • Phone: 310-529-9237
  • Fax: 626-331-3204
Mailing address:
  • Phone: 310-529-9237
  • Fax: 626-331-3204

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: DR. A.J. KHALIL
Title or Position: OWNER
Credential: MD
Phone: 310-529-9237