Healthcare Provider Details

I. General information

NPI: 1518015924
Provider Name (Legal Business Name): PACIFIC AMBULATORY SURGICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 09/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16260 VENTURA BLVD #800
ENCINO CA
91436-2203
US

IV. Provider business mailing address

11999 SAN VICENTE BLVD #440
LOS ANGELES CA
90049-5131
US

V. Phone/Fax

Practice location:
  • Phone: 818-906-5330
  • Fax:
Mailing address:
  • Phone: 310-471-5852
  • Fax: 310-471-3958

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: MS. RASHEL POURI
Title or Position: OWNER
Credential:
Phone: 818-906-5330