Healthcare Provider Details

I. General information

NPI: 1457959082
Provider Name (Legal Business Name): OPTILIFE SURGERY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2020
Last Update Date: 10/15/2020
Certification Date: 10/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 W ALAMEDA AVE STE 602
BURBANK CA
91505-4411
US

IV. Provider business mailing address

2701 W ALAMEDA AVE STE 602
BURBANK CA
91505-4411
US

V. Phone/Fax

Practice location:
  • Phone: 818-861-7149
  • Fax: 818-861-7159
Mailing address:
  • Phone: 818-861-7149
  • Fax: 818-861-7159

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: MRS. KRISTINA ARUTYUNYAN
Title or Position: DIRECTOR
Credential:
Phone: 818-861-7149