Healthcare Provider Details

I. General information

NPI: 1982180782
Provider Name (Legal Business Name): ROBERTSON SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2018
Last Update Date: 05/23/2025
Certification Date: 05/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

822 S ROBERTSON BLVD STE 100B
LOS ANGELES CA
90035-1613
US

IV. Provider business mailing address

822 S ROBERTSON BLVD STE 100B
LOS ANGELES CA
90035-1613
US

V. Phone/Fax

Practice location:
  • Phone: 310-651-6937
  • Fax: 310-651-6937
Mailing address:
  • Phone: 310-651-6937
  • Fax: 310-651-6937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: JOSEPH ENAYATI
Title or Position: PRESIDENT/MEDICAL DIRECTOR
Credential: DO
Phone: 310-651-6937