Healthcare Provider Details

I. General information

NPI: 1295070399
Provider Name (Legal Business Name): BURBANK SURGERY CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2012
Last Update Date: 09/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 W ALAMEDA AVE SUITE 602
BURBANK CA
91505-4402
US

IV. Provider business mailing address

2701 W ALAMEDA AVE SUITE 602
BURBANK CA
91505-4402
US

V. Phone/Fax

Practice location:
  • Phone: 818-846-1335
  • Fax:
Mailing address:
  • Phone: 818-846-1335
  • 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: DR. HUSSAM Y ANTOIN
Title or Position: OWNER/MEDICAL DIRECTOR
Credential: M.D.
Phone: 818-846-1335