Healthcare Provider Details

I. General information

NPI: 1376862664
Provider Name (Legal Business Name): SURGICAL CONCIERGE NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2010
Last Update Date: 05/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8635 WEST 3RD STREET STE 1170W
LOS ANGELES CA
90048
US

IV. Provider business mailing address

8635 WEST 3RD STREET STE 1170W
LOS ANGELES CA
90048
US

V. Phone/Fax

Practice location:
  • Phone: 310-854-3313
  • Fax: 310-691-8877
Mailing address:
  • Phone: 310-854-3313
  • Fax: 310-691-8877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License NumberA72696
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License NumberA72696
License Number StateCA

VIII. Authorized Official

Name: KARINE SARGSYAN
Title or Position: OFFICE MANAGER
Credential:
Phone: 310-854-3313