Healthcare Provider Details

I. General information

NPI: 1619499399
Provider Name (Legal Business Name): ADVANCED SURGICAL CENTER OF FOOTHILL RANCH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2017
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27462 PORTOLA PKWY STE 101
FOOTHILL RANCH CA
92610-2838
US

IV. Provider business mailing address

550 N BRAND BLVD STE 900
GLENDALE CA
91203-4721
US

V. Phone/Fax

Practice location:
  • Phone: 818-937-9969
  • Fax:
Mailing address:
  • Phone:
  • 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: CAROLINE TCHAMANIAN
Title or Position: COO
Credential: CASC
Phone: 818-937-9969