Healthcare Provider Details

I. General information

NPI: 1417503061
Provider Name (Legal Business Name): COHEN OUTPATIENT SURGERY CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2019
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 BALBOA BLVD STE 217
ENCINO CA
91316-5216
US

IV. Provider business mailing address

5400 BALBOA BLVD STE 217
ENCINO CA
91316-5216
US

V. Phone/Fax

Practice location:
  • Phone: 310-659-8111
  • Fax: 310-388-5222
Mailing address:
  • Phone: 310-659-8111
  • Fax: 310-388-5222

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: ELENA SERDA
Title or Position: DIRECTOR
Credential:
Phone: 661-472-4177