Healthcare Provider Details

I. General information

NPI: 1821481482
Provider Name (Legal Business Name): LA TOP SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2015
Last Update Date: 03/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 S CENTRAL AVE # 100A2
GLENDALE CA
91204-4370
US

IV. Provider business mailing address

800 S CENTRAL AVE # 100A2
GLENDALE CA
91204-4370
US

V. Phone/Fax

Practice location:
  • Phone: 818-424-8568
  • 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: DR. GEVORG MUTAFYAN
Title or Position: MANAGING MEMBER/OWNER.
Credential: M.D.
Phone: 818-424-8568