Healthcare Provider Details

I. General information

NPI: 1528707320
Provider Name (Legal Business Name): OMNI SURGERY CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2022
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 S BRAND BLVD
GLENDALE CA
91204-1701
US

IV. Provider business mailing address

317 S BRAND BLVD STE 102
GLENDALE CA
91204-1701
US

V. Phone/Fax

Practice location:
  • Phone: 818-338-6860
  • Fax:
Mailing address:
  • Phone: 818-338-6860
  • 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: MAXIM MORADIAN
Title or Position: CHAIRMAN, GOVERNING BODY
Credential: MD
Phone: 818-338-6860