Healthcare Provider Details

I. General information

NPI: 1992242192
Provider Name (Legal Business Name): UNIVERSAL CARE SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2017
Last Update Date: 02/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10866 RIVERSIDE DR
NORTH HOLLYWOOD CA
91602-2236
US

IV. Provider business mailing address

10866 RIVERSIDE DR
NORTH HOLLYWOOD CA
91602-2236
US

V. Phone/Fax

Practice location:
  • Phone: 818-980-8300
  • Fax: 818-980-8301
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: MR. BORIS TRIPOLSKI
Title or Position: ADMINISTRATOR
Credential:
Phone: 818-980-8300