Healthcare Provider Details

I. General information

NPI: 1487084075
Provider Name (Legal Business Name): GOLDEN STATE SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2013
Last Update Date: 11/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 HOLLAND STE 101
IRVINE CA
92618-2568
US

IV. Provider business mailing address

7320 WOODLAKE AVE STE 220
WEST HILLS CA
91307-1484
US

V. Phone/Fax

Practice location:
  • Phone: 949-588-2190
  • Fax: 949-588-2199
Mailing address:
  • Phone: 818-883-8477
  • Fax: 818-883-2223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberC40219
License Number StateCA

VIII. Authorized Official

Name: Z143H H VARTIVARIAN
Title or Position: PRESIDENT
Credential: MD
Phone: 818-883-8477