Healthcare Provider Details

I. General information

NPI: 1780074138
Provider Name (Legal Business Name): ONE SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2015
Last Update Date: 01/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 S CENTRAL AVE SUITE # 100A3
GLENDALE CA
91204-4370
US

IV. Provider business mailing address

800 S CENTRAL AVE SUITE # 100A3
GLENDALE CA
91204-4370
US

V. Phone/Fax

Practice location:
  • Phone: 213-387-0102
  • 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: CHRISTOPHE LEE
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 213-387-0102