Healthcare Provider Details

I. General information

NPI: 1104440189
Provider Name (Legal Business Name): CENTRAL SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2020
Last Update Date: 06/04/2020
Certification Date: 06/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 S CENTRAL AVE STE 102
GLENDALE CA
91204-4370
US

IV. Provider business mailing address

800 S CENTRAL AVE STE 102
GLENDALE CA
91204-4370
US

V. Phone/Fax

Practice location:
  • Phone: 818-388-0877
  • Fax:
Mailing address:
  • Phone: 818-388-0877
  • 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: NATALIE A PLYAMM
Title or Position: ADMINISTRATOR
Credential:
Phone: 818-388-0877