Healthcare Provider Details

I. General information

NPI: 1689324758
Provider Name (Legal Business Name): MIRACLE SURGERY CENTER,
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2022
Last Update Date: 03/24/2022
Certification Date: 03/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 CENTURY PARK EAST SUITE 606
LOS ANGELES CA
90067
US

IV. Provider business mailing address

2080 CENTURY PARK EAST SUITE 606
LOS ANGELES CA
90067
US

V. Phone/Fax

Practice location:
  • Phone: 310-274-4900
  • Fax:
Mailing address:
  • Phone: 310-274-4900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. FARZIN KERENDIAN
Title or Position: MEDICAL DIRECTOR
Credential: D.O.
Phone: 310-274-4900