Healthcare Provider Details

I. General information

NPI: 1487101069
Provider Name (Legal Business Name): GREAT BEGINNINGS SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16260 VENTURA BLVD SUITE 220
ENCINO CA
91436
US

IV. Provider business mailing address

16260 VENTURA BLVD SUITE 220
ENCINO CA
91436-2203
US

V. Phone/Fax

Practice location:
  • Phone: 818-292-2242
  • Fax: 818-292-8914
Mailing address:
  • Phone: 818-292-2242
  • Fax: 818-292-8914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0006X
TaxonomyAmbulatory Fertility Facility
License NumberA80341
License Number StateCA

VIII. Authorized Official

Name: ASHM KUMAR
Title or Position: MEMBER
Credential: MD
Phone: 818-292-2242