Healthcare Provider Details

I. General information

NPI: 1083205306
Provider Name (Legal Business Name): BRAND SURGICAL INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2021
Last Update Date: 01/29/2021
Certification Date: 01/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 W BROADWAY
GLENDALE CA
91204-1010
US

IV. Provider business mailing address

1141 N BRAND BLVD STE 200
GLENDALE CA
91202-2577
US

V. Phone/Fax

Practice location:
  • Phone: 818-243-9999
  • Fax: 818-243-9012
Mailing address:
  • Phone: 818-243-9999
  • Fax: 818-243-9999

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: ANGEL SAMVALIAN
Title or Position: CEO
Credential:
Phone: 818-402-7759