Healthcare Provider Details

I. General information

NPI: 1770496069
Provider Name (Legal Business Name): APG SURGICAL PAVILLION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 CENTURY PARK E STE 1111
LOS ANGELES CA
90067-2029
US

IV. Provider business mailing address

2080 CENTURY PARK E STE 500
LOS ANGELES CA
90067-2008
US

V. Phone/Fax

Practice location:
  • Phone: 661-388-4143
  • Fax:
Mailing address:
  • Phone: 661-388-4143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: ALEN TERNIAN
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 661-388-4143