Healthcare Provider Details

I. General information

NPI: 1982077269
Provider Name (Legal Business Name): ELITE SURGICAL CLINIC, MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2015
Last Update Date: 11/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 S. CENTRAL AVE. SUITE 100
GLENDALE CA
91204-2582
US

IV. Provider business mailing address

1510 S. CENTRAL AVE. SUITE 100
GLENDALE CA
91204-2582
US

V. Phone/Fax

Practice location:
  • Phone: 818-240-1820
  • Fax: 818-240-1021
Mailing address:
  • Phone: 818-240-1820
  • Fax: 818-240-1021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberG472240
License Number StateCA

VIII. Authorized Official

Name: DR. SUSAN L CHOBANIAN
Title or Position: OWNER
Credential: M.D.
Phone: 818-240-1820