Healthcare Provider Details

I. General information

NPI: 1851647549
Provider Name (Legal Business Name): CALIFORNIA SURGICAL SPECIALTY GROUP,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2012
Last Update Date: 03/20/2020
Certification Date: 03/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17114 DEVONSHIRE ST STE 102
NORTHRIDGE CA
91325-1619
US

IV. Provider business mailing address

17114 DEVONSHIRE ST STE 102
NORTHRIDGE CA
91325-1619
US

V. Phone/Fax

Practice location:
  • Phone: 818-998-6600
  • Fax: 818-659-7694
Mailing address:
  • Phone: 818-998-6600
  • Fax: 818-659-7694

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. KAMYAR AMINI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 818-998-6600