Healthcare Provider Details

I. General information

NPI: 1265896559
Provider Name (Legal Business Name): OPTIMA SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2016
Last Update Date: 04/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S CENTRAL AVE STE 126
GLENDALE CA
91204-2571
US

IV. Provider business mailing address

1500 S CENTRAL AVE STE 126
GLENDALE CA
91204-2571
US

V. Phone/Fax

Practice location:
  • Phone: 818-409-0060
  • Fax: 818-409-0066
Mailing address:
  • Phone: 818-409-0060
  • Fax: 818-409-0066

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: DR. CHRISTOPHER K KAYPEKIAN
Title or Position: CEO
Credential: M.D.
Phone: 818-409-0060