Healthcare Provider Details

I. General information

NPI: 1336082098
Provider Name (Legal Business Name): SURGERY CENTER OF SOUTHERN CALIFORNIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2026
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1451 E CHEVY CHASE DR STE 102
GLENDALE CA
91206-4056
US

IV. Provider business mailing address

1451 E CHEVY CHASE DR STE 102
GLENDALE CA
91206-4056
US

V. Phone/Fax

Practice location:
  • Phone: 818-409-1777
  • Fax:
Mailing address:
  • Phone: 818-409-1777
  • 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: MIREILLE HAMPARIAN
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 818-409-1777