Healthcare Provider Details

I. General information

NPI: 1609473420
Provider Name (Legal Business Name): ALDEN ADVANCED SURGICENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2020
Last Update Date: 10/05/2020
Certification Date: 09/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8741 ALDEN DRIVE SUITE B
LOS ANGELES CA
90048
US

IV. Provider business mailing address

8741 ALDEN DRIVE SUITE B
LOS ANGELES CA
90048
US

V. Phone/Fax

Practice location:
  • Phone: 310-652-2744
  • 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. MOINAKHTAR LALA
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 310-652-2744