Healthcare Provider Details

I. General information

NPI: 1558132316
Provider Name (Legal Business Name): LIFE SURGICAL ONCOLOGY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2024
Last Update Date: 01/11/2024
Certification Date: 01/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4515 CASTLE RD
LA CANADA CA
91011-1437
US

IV. Provider business mailing address

1439 COLINA DR
GLENDALE CA
91208-2410
US

V. Phone/Fax

Practice location:
  • Phone: 818-484-8049
  • Fax:
Mailing address:
  • Phone: 818-606-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. AVO ARTINYAN
Title or Position: CEO
Credential: MD, MS
Phone: 818-606-2200