Healthcare Provider Details

I. General information

NPI: 1699189894
Provider Name (Legal Business Name): CENTRAL SURGICAL CENTER PC A CALIFORNIA PROFESSIONAL MEDICAL CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2014
Last Update Date: 06/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 N CENTRAL AVE SUITE 201
GLENDALE CA
91203-1901
US

IV. Provider business mailing address

503 N CENTRAL AVE SUITE 201
GLENDALE CA
91203-1901
US

V. Phone/Fax

Practice location:
  • Phone: 818-265-9499
  • Fax:
Mailing address:
  • Phone:
  • 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: MICHAEL TAHERY
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 818-265-9499